Neonatal and Paediatric Intensive Care Unit

Verona, Italy

Neonatal and Paediatric Intensive Care Unit

Verona, Italy
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Berger T.M.,Neonatal and Paediatric Intensive Care Unit | Steurer M.A.,University of California at San Francisco | Woerner A.,Universitatskinderklinik | Meyer-Schiffer P.,Universitatsspital Zurich
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2012

Background: The publication of Swiss guidelines for the care of infants at the limit of viability (22-25 completed weeks) was followed by increased survival rates in the more mature infants (25 completed weeks). At the same time, considerable centre-to-centre (CTC) differences were noted. Objectives: To examine the trend of survival rates of borderline viable infants over a 10-year-period and to further explore CTC differences. Design: Population-based, retrospective cohort study. Setting: All nine level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals in Switzerland. Patients: 6532 preterm infants with a gestational age (GA) <32 weeks born alive between 1 January 2000 and 31 December 2009. Main outcome measures: Trends of GA-specific delivery room and NICU mortality rates and survival rates to hospital discharge were assessed. For CTC comparisons, centre-specific risk-adjusted ORs for survival were calculated in three GA groups: A: 23 0/7 to 25 6/7 weeks (n=976), B: 26 0/7 to 28 6/7 weeks (n=1943) and C: 29 0/7 to 31 6/7 weeks (n=3399). Results: Survival rates of infants with a GA of 25 completed weeks which had improved from 42% in 2000/2001 to 60% in 2003/2004 remained unchanged at 63% over the next 5 years (2005-2009). Statistically significant CTC differences have persisted and are not restricted to borderline viable infants. Conclusions: In Switzerland, survival rates of infants born at the limit of viability have remained unchanged over the second half of the current decade. Risk-adjusted CTC outcome variability cannot be explained by differences in baseline demographics or centre case loads.


Biban P.,Neonatal and Paediatric Intensive Care Unit
Minerva pediatrica | Year: 2010

Neonatal and paediatric intensive care units (NICUs and PICUs) are growing in number, size and complexity, and each unit is staffed by a highly specialized group of doctors and nurses. Indeed, practitioners within these subspecialties acquire specific cognitive and procedural skills garnered from focused multidisciplinary training, as well as from experience with critically ill newborns and children. Although the NICUs and PICUs share many commonalities, the relationship between caregivers in the neonatal and paediatric critical care units often is characterized by rivalry and antagonism rather than by cooperation. In addition, as in the Italian scenario, the scientific and professional background in most cases differ between neonatologists, predominantly coming from a paediatric-oriented curriculum, and paediatric intensivists, mainly affiliated to adult anaesthesia and intensive care residency programs. However, in some circumstances, particularly when dealing with smaller patients, the limits between these two distinct disciplines appear quite vague, and undoubtedly many clinicians have the perception that the two branches, namely neonatology and paediatric anaesthesia and intensive care, would get a mutual benefit by a stronger collaboration and cross-contamination. Indeed, in some situations, such as shortage of PICU beds or patients not easily transferable to a PICU, neonatologists are occasionally called to take care of critically ill infants and young children. However, these "paediatric" patients may often present with complex pathologies which the neonatologist may not be familiar with. This condition raises important issues about the advisability to provide specific education and training in paediatric intensive care also to neonatologists, according to local needs and caregivers' expectations.


Berger T.M.,Neonatal and Paediatric Intensive Care Unit
Archives of disease in childhood. Fetal and neonatal edition | Year: 2012

The publication of Swiss guidelines for the care of infants at the limit of viability (22-25 completed weeks) was followed by increased survival rates in the more mature infants (25 completed weeks). At the same time, considerable centre-to-centre (CTC) differences were noted. To examine the trend of survival rates of borderline viable infants over a 10-year-period and to further explore CTC differences. Population-based, retrospective cohort study. All nine level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals in Switzerland. 6532 preterm infants with a gestational age (GA) <32 weeks born alive between 1 January 2000 and 31 December 2009. Trends of GA-specific delivery room and NICU mortality rates and survival rates to hospital discharge were assessed. For CTC comparisons, centre-specific risk-adjusted ORs for survival were calculated in three GA groups: A: 23 0/7 to 25 6/7 weeks (n=976), B: 26 0/7 to 28 6/7 weeks (n=1943) and C: 29 0/7 to 31 6/7 weeks (n=3399). Survival rates of infants with a GA of 25 completed weeks which had improved from 42% in 2000/2001 to 60% in 2003/2004 remained unchanged at 63% over the next 5 years (2005-2009). Statistically significant CTC differences have persisted and are not restricted to borderline viable infants. In Switzerland, survival rates of infants born at the limit of viability have remained unchanged over the second half of the current decade. Risk-adjusted CTC outcome variability cannot be explained by differences in baseline demographics or centre case loads.


Biban P.,Neonatal and Paediatric Intensive Care Unit | Serra A.,Neonatal and Paediatric Intensive Care Unit | Polese G.,ULS | Soffiati M.,Neonatal and Paediatric Intensive Care Unit | Santuz P.,Neonatal and Paediatric Intensive Care Unit
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2010

Neurally adjusted ventilator assist (NAVA) is a new mode of partial ventilatory support, in which neural inspiratory activity is monitored through the continuous esophageal recording of the electrical activity of the diaphragm. Assistance is triggered and cycled off in according to this signal and is delivered in proportion to its intensity. NAVA can improve patient-ventilator synchrony while maintaining spontaneous breathing. Small preliminary studies have shown that NAVA can be successfully used also in term and preterm infants, being safe and well tolerated. However, much additional work is still needed before NAVA can be recommended in the everyday practice of the neonatologist. © 2010 Informa UK, Ltd.


PubMed | Neonatal and Paediatric Intensive Care Unit
Type: Journal Article | Journal: Minerva pediatrica | Year: 2010

Neonatal and paediatric intensive care units (NICUs and PICUs) are growing in number, size and complexity, and each unit is staffed by a highly specialized group of doctors and nurses. Indeed, practitioners within these subspecialties acquire specific cognitive and procedural skills garnered from focused multidisciplinary training, as well as from experience with critically ill newborns and children. Although the NICUs and PICUs share many commonalities, the relationship between caregivers in the neonatal and paediatric critical care units often is characterized by rivalry and antagonism rather than by cooperation. In addition, as in the Italian scenario, the scientific and professional background in most cases differ between neonatologists, predominantly coming from a paediatric-oriented curriculum, and paediatric intensivists, mainly affiliated to adult anaesthesia and intensive care residency programs. However, in some circumstances, particularly when dealing with smaller patients, the limits between these two distinct disciplines appear quite vague, and undoubtedly many clinicians have the perception that the two branches, namely neonatology and paediatric anaesthesia and intensive care, would get a mutual benefit by a stronger collaboration and cross-contamination. Indeed, in some situations, such as shortage of PICU beds or patients not easily transferable to a PICU, neonatologists are occasionally called to take care of critically ill infants and young children. However, these paediatric patients may often present with complex pathologies which the neonatologist may not be familiar with. This condition raises important issues about the advisability to provide specific education and training in paediatric intensive care also to neonatologists, according to local needs and caregivers expectations.


PubMed | Neonatal and Paediatric Intensive Care Unit
Type: Journal Article | Journal: Archives of disease in childhood. Fetal and neonatal edition | Year: 2012

The publication of Swiss guidelines for the care of infants at the limit of viability (22-25 completed weeks) was followed by increased survival rates in the more mature infants (25 completed weeks). At the same time, considerable centre-to-centre (CTC) differences were noted.To examine the trend of survival rates of borderline viable infants over a 10-year-period and to further explore CTC differences.Population-based, retrospective cohort study.All nine level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals in Switzerland.6532 preterm infants with a gestational age (GA) <32 weeks born alive between 1 January 2000 and 31 December 2009.Trends of GA-specific delivery room and NICU mortality rates and survival rates to hospital discharge were assessed. For CTC comparisons, centre-specific risk-adjusted ORs for survival were calculated in three GA groups: A: 23 0/7 to 25 6/7 weeks (n=976), B: 26 0/7 to 28 6/7 weeks (n=1943) and C: 29 0/7 to 31 6/7 weeks (n=3399).Survival rates of infants with a GA of 25 completed weeks which had improved from 42% in 2000/2001 to 60% in 2003/2004 remained unchanged at 63% over the next 5 years (2005-2009). Statistically significant CTC differences have persisted and are not restricted to borderline viable infants.In Switzerland, survival rates of infants born at the limit of viability have remained unchanged over the second half of the current decade. Risk-adjusted CTC outcome variability cannot be explained by differences in baseline demographics or centre case loads.

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