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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
Acta bio-medica : Atenei Parmensis | Year: 2012

Exogenous surfactant is a therapeutic option for newborns, children and adults with acute respiratory distress disorders. Although tracheal instillation is still reputed as the classical method of surfactant delivery, alternative techniques have been investigated. Surfactant administration by using thin intra-tracheal catheters, bronchoscopy, laryngeal mask airway, or nebulisation, although variably effective, appear to be less invasive when compared to tracheal intubation. However, further research is still needed to better clarify this matter. (www.actabiomedica.it).

Berger T.M.,Neonatal and Paediatric Intensive Care Unit
European Journal of Anaesthesiology | Year: 2012

Although approximately 10% of all newborn infants receive some form of assistance after birth, only 1% of neonates require more advanced measures of life support. Because such situations cannot always be anticipated, paediatricians and neonatologists are frequently unavailable and resuscitation is delegated to the anaesthesiologist. The International Liaison Committee on Resuscitation, the European Resuscitation Council and the American Heart Association have recently updated the guidelines on neonatal resuscitation. The revised guidelines propose a simplified resuscitation algorithm that highlights the central role of respiratory support and promotes an increasing heart rate as the best indicator for effective ventilation. The most striking change in the new guidelines is the recommendation to start resuscitation in term infants with room air rather than 100% oxygen. Continuous pulse oximetry is recommended to monitor both heart rate and an appropriate increase in preductal oxygen saturation. Supplemental oxygen should only be used if, despite effective ventilation, the heart rate does not increase above 100 beats min1, or if oxygenation as indicated by pulse oximetry, remains unacceptably low. This review will focus on foetal physiology and pathophysiological aspects of neonatal adaptation and, thus, attempt to provide a solid basis for understanding the new resuscitation guidelines. © 2012 Copyright European Society of Anaesthesiology.

Johr M.,Paediatric Anaesthesia | Berger T.M.,Neonatal and Paediatric Intensive Care Unit
Current Opinion in Anaesthesiology | Year: 2015

Purpose of review The aim of this review was to discuss recent developments in paediatric anaesthesia, which are particularly relevant to the practitioner involved in paediatric outpatient anaesthesia. Recent findings The use of a pharmacological premedication is still a matter of debate. Several publications are focussing on nasal dexmedetomidine; however, its exact place has not yet been defined. Both inhalational and intravenous anaesthesia techniques still have their advocates; for diagnostic imaging, however, propofol is emerging as the agent of choice. The disappearance of codeine has left a breach for an oral opioid and has probably worsened postoperative analgesia following tonsillectomy. In recent years, a large body of evidence for the prevention of postoperative agitation has appeared. Alpha-2-agonists as well as the transition to propofol play an important role. There is now some consensus that for reasons of practicability prophylactic antiemetics should be administered to all and not only to selected high-risk patients. Summary Perfect organization of the whole process is a prerequisite for successful paediatric outpatient anaesthesia. In addition, the skilled practitioner is able to provide a smooth anaesthetic, minimizing complications, and, finally, he has a clear concept for avoiding postoperative pain, agitation and vomiting. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Stocker M.,Neonatal and Paediatric Intensive Care Unit | Burmester M.,Paediatric Intensive Care Unit | Allen M.,University of Melbourne
BMC Medical Education | Year: 2014

Background: As a conceptual review, this paper will debate relevant learning theories to inform the development, design and delivery of an effective educational programme for simulated team training relevant to health professionals. Discussion. Kolb's experiential learning theory is used as the main conceptual framework to define the sequence of activities. Dewey's theory of reflective thought and action, Jarvis modification of Kolb's learning cycle and Schön's reflection-on-action serve as a model to design scenarios for optimal concrete experience and debriefing for challenging participants' beliefs and habits. Bandura's theory of self-efficacy and newer socio-cultural learning models outline that for efficient team training, it is mandatory to introduce the social-cultural context of a team. Summary. The ideal simulated team training programme needs a scenario for concrete experience, followed by a debriefing with a critical reflexive observation and abstract conceptualisation phase, and ending with a second scenario for active experimentation. Let them re-experiment to optimise the effect of a simulated training session. Challenge them to the edge: The scenario needs to challenge participants to generate failures and feelings of inadequacy to drive and motivate team members to critical reflect and learn. Not experience itself but the inadequacy and contradictions of habitual experience serve as basis for reflection. Facilitate critical reflection: Facilitators and group members must guide and motivate individual participants through the debriefing session, inciting and empowering learners to challenge their own beliefs and habits. To do this, learners need to feel psychological safe. Let the group talk and critical explore. Motivate with reality and context: Training with multidisciplinary team members, with different levels of expertise, acting in their usual environment (in-situ simulation) on physiological variables is mandatory to introduce cultural context and social conditions to the learning experience. Embedding in situ team training sessions into a teaching programme to enable repeated training and to assess regularly team performance is mandatory for a cultural change of sustained improvement of team performance and patient safety. © 2014Stocker et al.; licensee BioMed Central Ltd.

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