Time filter

Source Type

Emeriaud G.,University of Montreal | Larouche A.,University of Montreal | Ducharme-Crevier L.,University of Montreal | Massicotte E.,University of Montreal | And 7 more authors.
Intensive Care Medicine

Purpose: Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.Methods: This was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.Results: Fifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdimax) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2–7.6] μV in the acute phase and 4.8 (IQR 2.0–10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdimax in spontaneous ventilation was 15.4 (IQR 7.4–20.7) μV shortly after extubation and 12.6 (IQR 8.1–21.3) μV before PICU discharge. The difference in EAdimax between mechanical ventilation and post-extubation periods was significant (p < 0.001). Patients intubated mainly because of a lung pathology exhibited higher EAdi (p < 0.01), with a similar temporal increase.Conclusions: This is the first systematic description of EAdi evolution in children during their stay in the PICU. In our patient cohort, diaphragm activity was frequently low in conventional ventilation, suggesting that overassistance or oversedation is common in clinical practice. EAdi monitoring appears to be a helpful tool to detect such situations. © 2014, Springer-Verlag Berlin Heidelberg and ESICM. Source

Heidmets L.-T.,University of Tartu | Metsvaht T.,University of Tartu | Ilmoja M.-L.,Pediatric and Neonatal Intensive Care Unit | Pisarev H.,University of Tartu | And 2 more authors.

Background: The amount of blood that can be safely drawn from a preterm neonate for scientific purposes is poorly established. Objectives: To provide scientific evidence on the amount of blood that can be drawn from very low birth weight (VLBW) neonates for study purposes. Methods: We performed a post-hoc analysis of a pharmacokinetic (PK) study of penicillin-G, enrolling 18 neonates with a birth weight of <1,200 g, gestational age of <28 weeks and postnatal age of <5 days, with a risk of early onset sepsis. A median of 2.3 ml/kg of blood was collected from each neonate for the PK analysis. Hemoglobin (Hgb), hematocrit (Ht), basic hemodynamic parameters, total fluid intake, number of blood component transfusions and number of blood analysis for clinical indications were recorded. The control group consisted of 35 gestational age-, postnatal age- and birth weight-matched neonates who had not participated in a PK study. Results: We did not observe significant differences in any studied safety parameter, including Hgb and Ht values, between the two groups. Median number of blood component transfusions (n = 2 in both groups), median volume of transfused red blood cells (22 vs. 24 ml/kg in study vs. control group) and total daily fluid requirement were similar. The median calculated blood loss on clinical indications was 1.9 ml/24 h in the control group and 1.66 ml/24 h in the study group. Conclusions: In VLBW neonates, up to 2.3 ml/kg of blood (corresponding to 2.4% of calculated circulating blood volume) can be drawn for scientific purposes without compromising basic hemodynamic parameters, Hgb and Ht values, blood component transfusions or fluid requirements. Copyright © 2011 S. Karger AG, Basel. Source

Biasini A.,Pediatric and Neonatal Intensive Care Unit
Journal of biological regulators and homeostatic agents

Postnatal growth restriction and failure to thrive still remain a major problem in Extremely Low Birth Weight (ELBW) infants . The goal for the nutritional care of these infants is to achieve rate of growth similar to those of the fetus in utero at the equivalent gestational age. Human milk fortified remains the best food for all these preterms. Two groups of preterm of weight 580-1250 g and gestational age 23-32 wk, were fed with different protein intake in the human/maternal milk fortified ( 3,5 g Kg-1 per day and 4,8 g Kg-1 per day in the control and intervention group respectively).The feeding tolerance, intrahospital growth, neurological outcome and anthropometric data until 12 months of corrected age, were evaluated. The protein supplemented group (PSG) showed an intrahospital highter growth rate ( mostly in head circumference, p 0,02, and length growth, p 0,04) only in the preterms with 580-980 g and 23-30 wk. In the same preterms, Griffith Development Mental Score at 3 and 12 months corrected age showed higher score than in the control group in the Performance (p 0,04) and Hearing/Language (p 0,03) items. The auxological evaluation in the postdischarge period showed in the PSG group mean z-score values for length higher than those in the control group at 9 (p 0,04) months of corrected age. Source

Piotrowski A.,Medical University of Lodz | Dabrowska-Wojciak I.,Medical University of Lodz | Mikinka M.,Medical University of Lodz | Fendler W.,Medical University of Lodz | And 3 more authors.
Journal of Maternal-Fetal and Neonatal Medicine

Background.The association between intraventricular hemorrhage (IVH) and coagulation in infants has been a subject of controversy. Only few publications assessing risk factors for development of IVH reported results of coagulation studies. Objectives.To evaluate the levels of coagulation and fibrinolysis systems in ELBW infants and determine their influence on IVH. Patients and methods.Following IRB approval coagulation status of 38 ELBW infants was evaluated on first and second day of life. Severity of IVH assessed by cerebral ultrasonography was graded according to Papile classification. Newborns were assigned to either Group A Grade III or IV, or Group B Grade III, or no IVH. Results.Neonates with Grade III/IV IVH had significantly lower plasma Factor VII (FVII) level on first day of life and FVII differed significantly between Groups A and B with sensitivity of 100, specificity 41 for a cut-off value of<7. In Group A there was no improvement of prothrombin and activated partial thromboplastin times on Day 2. A significant decline of platelet count was also observed. Conclusions.High-grade IVH coincides with severe derangement of coagulation in ELBW infants with FVII level being the most sensitive, it is not clear what reason for such low FVII concentration is. Further studies are indicated. © 2010 Informa UK Ltd. Source

Biasini A.,Pediatric and Neonatal Intensive Care Unit | Fantini F.,Alma Materials University | Neri E.,Alma Materials University | Stella M.,Pediatric and Neonatal Intensive Care Unit | Arcangeli T.,University of Bologna
Journal of Maternal-Fetal and Neonatal Medicine

Aim: Communication between the healthcare team and the parents in Neonatal Intensive Care Unit (NICU) is very important, and may affect both trust in medical team and the health of premature babies. The aim of this study is to confirm that a good relationship with families can be obtained if all the healthcare team adopts a good common communication scheme. Methods: We have implemented a communication strategy that works through three stages: (1) Training in Communication: a course about general problems with communication for medical and nursing staff. (2) Communicative Algorithm: various guidelines to follow during the most common scenarios in the NICU. (3) Communicative Case Sheet: a notebook used to record any problem or discomfort that occurs during communication. We applied the strategy for a 12 months trial period. Results: A Systemic Counselling Institute of Medical Psychology tested families' satisfaction at the end of the period. The test showed that in 75% of cases, satisfaction with communication was very good and in the remaining 25%, parents perceived communication as good, but improvable. Conclusion: In NICU, communication between the members of the team and the newborn's parents may be improved by specific tools. © 2012 Informa UK, Ltd. Source

Discover hidden collaborations