Perth, Australia
Perth, Australia

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McLeod G.,Curtin University Australia | McLeod G.,Neonatal Clinical Care Unit | Simmer K.,Neonatal Clinical Care Unit | Simmer K.,Women and Infants Research Foundation | And 8 more authors.
Journal of Paediatrics and Child Health | Year: 2011

Aim: To document post-discharge feeding practices of preterm infants with chronic lung disease (CLD) and determine if sufficient protein and energy is consumed for optimal growth. Method: Protein and energy intakes of preterm infants with CLD were quantified through detailed analysis of measured food and fluid intakes at four corrected age (CA) assessments, post-discharge. Most of the infants were in hospital for the term assessment. Milk intake from breastfeeding was determined by test weighing. Protein and energy intakes were compared with the Australian and New Zealand Nutrient Reference Values (NRV) for healthy term-born infants, and CA z-scores for weight, length and head circumference were calculated using Australian national gestational growth data and Centre for Disease Control 2000 growth data. Results: Ten of the 28 CLD infants who were exclusively receiving expressed breast milk in hospital were transitioned to infant formula within 1 month of discharge. Complementary foods were introduced at a median CA of 3.6 months. Protein intakes almost always exceeded the NRV for healthy term-born infants, and at each assessment, at least 63% of infants met the energy NRV. Longitudinal growth data are available for 20 infants, four of whom had been small for gestational age. At the 12-month assessment, 10 of these infants weighed less than the 10th percentile. Conclusion: Preterm infants who develop CLD do not always achieve reference growth in their first year following discharge, despite protein and energy intakes being mostly comparable to those recommended for healthy term-born infants. © 2010 The Authors Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).


Kaczka D.W.,University of Iowa | Herrmann J.,University of Iowa | Zonneveld C.E.,Neonatal Research | Tingay D.G.,University of Melbourne | And 5 more authors.
Anesthesiology | Year: 2015

Background: Despite the theoretical benefits of high-frequency oscillatory ventilation (HFOV) in preterm infants, systematic reviews of randomized clinical trials do not confirm improved outcomes. The authors hypothesized that oscillating a premature lung with multiple frequencies simultaneously would improve gas exchange compared with traditional single-frequency oscillatory ventilation (SFOV). The goal of this study was to develop a novel method for HFOV, termed "multifrequency oscillatory ventilation" (MFOV), which relies on a broadband flow waveform more suitable for the heterogeneous mechanics of the immature lung. Methods: Thirteen intubated preterm lambs were randomly assigned to either SFOV or MFOV for 1 h, followed by crossover to the alternative regimen for 1 h. The SFOV waveform consisted of a pure sinusoidal flow at 5 Hz, whereas the customized MFOV waveform consisted of a 5-Hz fundamental with additional energy at 10 and 15 Hz. Per standardized protocol, mean pressure at airway opening () and inspired oxygen fraction were adjusted as needed, and root mean square of the delivered oscillatory volume waveform (Vrms) was adjusted at 15-min intervals. A ventilatory cost function for SFOV and MFOV was defined as, where Wt denotes body weight. Results: Averaged over all time points, MFOV resulted in significantly lower VC (246.9 ± 6.0 vs. 363.5 ± 15.9 ml2 mmHg kg-1) and (12.8 ± 0.3 vs. 14.1 ± 0.5 cm H2O) compared with SFOV, suggesting more efficient gas exchange and enhanced lung recruitment at lower mean airway pressures. Conclusion: Oscillation with simultaneous multiple frequencies may be a more efficient ventilator modality in premature lungs compared with traditional single-frequency HFOV. © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

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