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Parkville, Australia

Cheong J.L.,Newborn Research | Cheong J.L.,Murdoch Childrens Research Institute | Cheong J.L.,University of Melbourne | Anderson P.,Murdoch Childrens Research Institute | And 5 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2013

Objective: Postnatal corticosteroids (PCS) are used to prevent or treat bronchopulmonary dysplasia (BPD) in extremely low birthweight (ELBW; <1000 g) or extremely preterm (EPT; <28 weeks) infants. In the early 2000s, concerns were raised about increased risks of cerebral palsy (CP) in association with PCS, which may have affected prescribing of PCS, and influenced rates of BPD, mortality or long-term neurosensory morbidity. Our aim was to determine the changes over time in the rates of PCS use and 2-year outcomes in ELBW/EPT infants in Victoria, Australia. Design: All ELBW or EPT infants born in Victoria, Australia in three distinct eras (1991 -92, 1997 and 2005) who were alive at 7 days were included. Rates of PCS use, rates of BPD (oxygen dependency at 36 weeks' corrected age), death before 2 years of age, CP and major disability (any of moderate/severe CP, developmental quotient <-2 SD, blindness or deafness) were contrasted between cohorts. Results: The rate of PCS use and the dose prescribed diminished significantly in 2005 compared with earlier eras, but the rate of BPD rose. Non-significant changes in the rates of mortality over time were mirrored by nonsignificant changes in the rates of CP or major disability. Combined outcomes of mortality with either major disability or CP were similar over the three eras. Conclusions: PCS use decreased in 2005 compared with earlier eras, and was accompanied by a rise in BPD, with no significant changes in mortality or neurological morbidity. Source

Fathabadi O.S.,University of Tasmania | Gale T.J.,University of Tasmania | Lim K.,Royal Hobart Hospital | Salmon B.P.,University of Tasmania | And 5 more authors.
Neonatology | Year: 2015

Background: Oxygen saturation (SpO2) targeting in the preterm infant may be improved with a better understanding of the SpO2 responses to changes in inspired oxygen (FiO2). Objective: We investigated the first-order FiO2-SpO2 relationship, aiming to quantify the parameters governing that relationship, the influences on these parameters and their variability. Methods: In recordings of FiO2 and SpO2 from preterm infants on continuous positive airway pressure and supplemental oxygen, we identified unique FiO2 adjustments and mapped the subsequent SpO2 responses. For responses identified as first-order, the delay, time constant and gain parameters were determined. Clinical and physiological predictors of these parameters were sought in regression analysis, and intra- and inter-subject variability was evaluated. Results: In 3,788 h of available data from 47 infants at 31 (28-33) post-menstrual weeks [median (interquartile range)], we identified 993 unique FiO2 adjustments followed by a first-order SpO2 response. All response parameters differed between FiO2 increments and decrements, with increments having a shorter delay, longer time constant and higher gain [2.9 (1.7-4.8) vs. 1.3 (0.58-2.6), p < 0.05]. Gain was also higher in less mature infants and in the setting of recent SpO2 instability, and was diminished with increasing severity of lung dysfunction. Intra-subject variability in all parameters was prominent. Conclusions: First-order SpO2 responses show variable gain, influenced by the direction of FiO2 adjustment and the severity of lung disease, as well as substantial intra-subject parameter variability. These findings should be taken into account in adjustment of FiO2 for SpO2 targeting in preterm infants. © 2015 S. Karger AG, Basel. All rights reserved. Source

Mawson I.E.,University of Oxford | Dawson J.A.,Newborn Research | Dawson J.A.,Murdoch Childrens Research Institute | Donath S.M.,University of Melbourne | And 3 more authors.
Journal of Paediatrics and Child Health | Year: 2011

Aim: The study aims to investigate pulse oximetry measurements from a 'blue' pulse oximeter sensor against measurements from a 'standard' pulse oximeter sensor in newly born infants. Methods: Immediately after birth, both sensors were attached to the infant, one to each foot. SpO2 measurements were recorded simultaneously from each sensor for 10 min. Agreement between pairs of SpO2 measurements were calculated using Bland-Altman analysis. Results: Thirty-one infants were studied. There was good correlation between simultaneous SpO2 measurements from both sensors (r2= 0.75). However, the mean difference between 'blue' and 'standard' sensors was -1.6%, with wide 95% limits of agreement +18.4 to -21.6%. The range of mean difference between sensors from each infant ranged from -20 to +20. Conclusion: The mean difference between the blue and standard sensor SpO2 measurements is not clinically important. © 2011 The Authors. Source

Smirk C.L.,Royal Womens Hospital | Bowman E.,Womens Alcohol and Drug Service | Doyle L.W.,Newborn Research | Doyle L.W.,University of Melbourne | And 3 more authors.
Acta Paediatrica, International Journal of Paediatrics | Year: 2014

Aim Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome, secondary to in utero chemical exposure and characterised by tremor, irritability and feed intolerance. It often requires prolonged hospital treatment and separation of families. Outpatient therapy may reduce this burden, but current literature is sparse. This review aimed to evaluate the safety and efficacy of our home-based detoxification programme and compare it with standard inpatient care. Methods Infants requiring treatment for NAS between January 2004 and December 2010 were reviewed. Data on demographics, drug exposure, length of stay and type of therapy were compared between infants selected for home-based therapy and those treated conventionally. Results Of the 118 infants who were admitted for treatment of NAS, 38 (32%) were managed at home. Infants receiving home-based detoxification had shorter hospital stays (mean 19 days vs. 39 days), with no increase in total duration of treatment (mean 36 days vs. 41 days), and were more likely to be breastfeeding on discharge from hospital care (45% vs. 22%). Conclusion In selected infants, home-based detoxification is associated with reduced hospital stays and increased rates of breastfeeding, without prolonging therapy. Safety of the infants remains paramount, which precludes many from entering such a programme. ©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd. Source

Schmolzer G.M.,Murdoch Childrens Research Institute | Schmolzer G.M.,Newborn Research | Schmolzer G.M.,Monash Institute of Medical Research | Schmolzer G.M.,Medical University of Graz | And 9 more authors.
Pediatric Pulmonology | Year: 2013

Rationale Endotracheal tube (ETT) malposition is common and an increasing number of non-invasive techniques to aid rapid identification of tube position are available. Electrical impedance tomography (EIT) is advocated as a tool to monitor ventilation. Objective This study aimed to compare EIT with five other non-invasive techniques for identifying ETT position in a piglet model. Methodology Six saline lavage surfactant-depleted piglets were studied. Periods of ventilation with ETT placed in the oesophagus or a main bronchus (MB) were compared with an appropriately placed mid-tracheal ETT. Colorimetric end-tidal CO2 (Pedi-Cap®), SpO2 and heart rate, tidal volume VTao using a hot-wire anemometer at the airway opening, tidal volume using respiratory inductive plethysmography VTRIP and regional tidal ventilation within each hemithorax (EIT) were measured. Results Oesophageal ventilation: Pedi-Cap® demonstrated absence of color change. V Tao, VTRIP, and EIT correctly demonstrated no tidal ventilation. SpO2 decreased from mean (SD) 96 (2)% to 74 (12)% (P < 0.05; Bonferroni post-test), without heart rate change. MB ventilation: SpO2, heart rate and Pedi-Cap® were unchanged compared with mid-tracheal position. VTao and VTRIP decreased from a mean (SD) 10.8 (5.6) ml/kg and 14.6 (6.2) ml/kg to 5.5 (1.9) ml/kg and 6.4 (2.6) ml/kg (both P < 0.05; Bonferroni post-test). EIT identified the side of MB ventilation, with a mean (SD) 95 (3)% reduction in tidal volume in the unventilated lung. Conclusions EIT not only correctly identified oesophageal ventilation but also localized the side of MB ventilation. At present, no one technique is without limitations and clinicians should utilize a combination in addition to clinical judgement. Pediatr Pulmonol. 2013; 48:138-145. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc. Source

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