Effect of blood transfusion on apnoea, bradycardia and hypoxaemia in preterm infants

We studied the effect of blood transfusion on the frequency of apnoea, bradycardia and hypoxaemia in 21 spontaneously breathing preterm infants with a median gestational age at birth of 28 (range 23–31) weeks. Age at time of study was 22 days (3–84), weight 925 g (640–2120). The patients exhibited frequent episodes of bradycardia and/or hypoxaemia and were anaemic (median haemoglobin level 109 (82–120) g/l). One infant received two transfusions and was thus studied twice. Four-hour recordings of pulse oximeter saturation (SpO₂), pulse waveforms, transcutaneous oxygen pressure, electrocardiogram, breathing movements and nasal airflow were performed immediately before and after transfusion, and again after a further interval of 12 h. Recordings were analysed for isolated and periodic apnoeas (> 4 s), bradycardias (heart rate < 2/3 of baseline), and episodic desaturation (SpO₂≤ 80%). There were no significant changes in the frequency, severity and/or duration of apnoea, bradycardia or desaturation following transfusion. The average SpO₂ nadir reached during each desaturation, however, increased by 3% following transfusion (P < 0.05), and there was a trend towards shorter desaturations. Conclusion The occurrence of frequent episodes of apnoea, bradycardia and/or hypoxaemia does not, on its own, justify a blood transfusion in moderately anaemic preterm infants. Received: 25 July 1996 / Accepted: 24 September 1996     

Evaluation of surfactant function at birth determined by the stable microbubble test in term and near term infants with respiratory distress

Surfactant function using the stable microbubble test (SMT) was investigated in term or near term infants with respiratory distress. Newborn infants 34 weeks gestation with an initial clinical hypothesis of transient tachypnoea of the newborn (TTN) needing supplemental oxygen and controls were included. Gastric aspirates were collected immediately after birth for SMT. The first chest X-ray films were examined by three independent radiologists and according to their interpretation the babies were divided into a TTN, a respiratory distress syndrome of the newborn (RDS), or a poorly-defined X-ray group. A total of 32 infants with respiratory distress and 32 controls with similar gestational age and birth weight were studied. The median and interquartile range (IQR) of the stable microbubble (SMB) count was significantly lower (P<0.001) for the respiratory distress group than for the control group (17; range 6–33 versus 120; range 79–275). The proportion of babies with less than 35 stable microbubbles/mm² (SMB/mm²) was significantly different for the whole respiratory distress group (24/32–75%) and for the TTN (9/13–69%), the RDS (5/5–100%), and the poorly-defined (10/12–83%) groups as compared with the controls (2/32–6%; P<0.05). A total of 24/26 babies (92%) who needed oxygen for 24 h but only 1/6 (17%) of them who needed <24 h had a bubble count of less than 35 SMB/mm² (P<0.05). Conclusion: the results suggest that deficiency or dysfunction of the surfactant system is involved in the majority of cases of respiratory distress in near term and possibly term babies. The stable microbubble test can enable clinicians to take an earlier decision to give surfactant to term or near term infants with more severe and progressive respiratory distress.Abbreviations RDS respiratory distress syndrome of the newborn - SMB stable microbubbles - SMT stable microbubble test - TTN transient tachypnoea of the newborn     

A European multicenter randomized controlled trial of single dose surfactant therapy for idiopathic respiratory distress syndrome

We performed a multicenter prospective randomized controlled trial to determine the efficacy and safety of the surfactant preparation, Survanta (Abbott Laboratories, Chicago, USA), for 750–1750 g infants with idiopathic respiratory distress syndrome, (IRDS) receiving assisted ventilation with 40% or more oxygen. One hundred and six eligible infants from the eight participating centers were randomly assigned between March 1986 and June 1987 to receive either surfactant (100 mg phospholipid/kg, 4 ml/kg) or air (4 ml/kg) administered into the trachea within 8 h of brith (median time of treatment 6.2 h, range 3.2–9.1 h). The study was stopped before enrollment was completed at the request of the United States Food and Drug Administration when significant differences were observed in incidence of periventricular-intraventricular hemorrhage (PIH), between the surfactant treated and control infants. Surfactant treated infants had larger average increases in the arterial-alveolar oxygen ratio, (a/A ratio) (P<0.0001), and larger average decreases in FiO₂ (P<0.0001) and mean airway pressure, (MAP) (P<0.017) than controls over the 48 h following treatment. The magnitude of the differences between the surfactant and control groups were 0.19 (SE=0.03) for a/A ratio, –0.28 (SE=0.04) for FiO₂ and –1.7 cm H₂O (SE=0.70) for MAP. The clinical status on days 7 and 28 after treatment was classified using four predefined ordered categories: (1) no respiratory support; (2) supplemental O₂ with or without continuous positive airway pressure (CPAP); (3) intermittent mandatory ventilation; and (4) death. There were no statistically significant differences in the status categories on days 7 or 28 between surfactant and control infants. There were no significant differences between the groups with respect to the incidence of patent ductus arteriosus, bronchopulmonary dysplasia, necrotizing entero-colitis, air leaks or death. There was a statistically significant difference between treated and control infants in the frequency and severity of periventricular-intraventricular hemorrhage (PIH) (Cochran-Mantel-Haenszel ²adj=6.36,P=0.01). Hemorrhages occurred in 59.6% of surfactant treated infants and 26.9% of controls. Severe hemorrhages (grades 3 or 4) occurred in 38.5% of surfactant treated infants and 15.4% of controls ( ²adj=4.01,P=0.045). We conclude that the intratracheal administration of Survanta prior to 8 h of age to infants with IRDS receiving assisted ventilation with 40% or more oxygen results in a reduction in the severity of respiratory distress during the 48 h after therapy. Because of the difference in incidence of PIH between surfactant and control infants in this study, we recommend that future clinical trials of surfactant include more frequent prospective serial ultrasound evaluations for diagnosis of hemorrhage.     

Serum creatinine concentration,urinary creatinine excretion and creatinine clearance during the first 9 weeks in preterm infants with a birth weight below 1500 g

Abstract Little is known about serum creatinine concentration, urinary creatinine excretion and creatinine clearance in preterm infants. The aim of the present study was to establish age related reference values for the first weeks of life in preterm infants with a birth weight<1500 g. In addition, the possible influence of therapy with dexamethasone, spironolactone and catecholamines was investigated. In 34 patients, serum creatinine, urinary creatinine excretion and creatinine clearance were measured at weeks 1, 2, 3–4, 5–6 and 7–9 of life. Median birth weight was 1225 g (range 730–1495), mean gestational age 29 (range 26–34) weeks. Concentration of creatinine in serum and urine, urinary creatinine excretion per kilogram body weight and creatinine clearance showed a significant correlation with postnatal age. Thus age related reference values as proposed given in the present study are desirable. Median serum creatinine concentration decreased continuously within the first weeks of life: 97 (10–90th percentile: 69–141) in the 1st week, 70 (45–99) in the 2nd week, 57 (39–71) at week 3–4, 51 (42–62) at week 5–6 and 44 (39–48) mol/l at week 7–9. Median creatinine output in mol/kg body weight was 100 (10–90th percentile: 62–160) in the 1st week, 92 (65–120) in the 2nd week, 79 (52–122) at week 3–4, 89 (68–106) at week 5–6 and 86 (54–109) mol/kg/d at week 7–9. Creatinine clearance increased significantly within the first weeks of life. Values were 12.5 (10–90 the percentile: 7–22) in the 1st week, 16 (10–28) in the 2nd week, 20 (11–34) at weeks 3–4, 23 (15–36) at weeks 5–6 and 29 (17–36) ml/min per 1.73 m² at weeks 7–9. Therapy with dexamethasone, spironolactone or catecholamines showed no influence on creatinine excretion. Creatinine clearance did not only depend on postnatal age but also on gestational age and on the necessity of mechanical ventilation. These findings indicate a reduced glomerular filtration rate in very immature and severely ill preterm infants.Conclusion It might be necessary to lower dosage of renal excreted drugs in very immature and mechanically ventilated infants according to the creatinine clearance.     

‘Propped and prone’ positioning reduces respiratory events in spontaneously breathing preterm infants: A randomised triple crossover study

Aim

We compared effects of infant positioning and feed-rate interventions on respiratory events and oximetry parameters in spontaneously breathing preterm infants born <32 weeks gestation managed in a neonatal unit.

Methods

A randomised triple crossover design was employed. n = 68 infants underwent three test conditions A: control (supine/flat, gravity bolus feeds), B: position intervention (propped/prone) and C: feed-rate intervention (continuous pump feeds) in randomised sequence over three consecutive days. Primary outcomes were number of events (apnoea, bradycardia and desaturation) and percentage time SpO₂ < 80% over 24 h. The secondary outcome was percentage time SpO₂ ≥ 88%. Treatment effects were estimated using linear mixed-effects models.

Results

Propped/prone positioning significantly reduced events and improved percentage time SpO₂ < 80% and ≥88% compared to both other conditions (all P < 0.001). Outcomes for the feed-rate intervention were not significantly different to control.

Conclusions

Alternative infant positioning should be considered in preterm infants managed in the neonatal unit.     

Percentiles of oxygen saturations in healthy term newborns in the first minutes of life

The aim of this study was to establish the reference values of preductal oxygen saturation (SpO₂) in healthy infants immediately after birth. SpO₂ recordings of 200 term neonates (vaginal group;n=150 and cesarean group;n=50) with regular respiratory pattern were evaluated. The median SpO₂ values in the first, fifth and tenth minutes were 71, 92, and 98% in vaginal deliveries and 70, 79, and 96% in cesarean deliveries, respectively. SpO₂ was significantly lower in the cesarean group at any time after the first minute of life (p<0.0001). The time needed to reach a SpO₂>90% was three times longer in cesarean deliveries. Healthy neonates are poorly saturated immediately after birth. The duration to reach a SpO₂>90% was longer in infants born by cesarean deliveries. This study was supported by The Marmara University Scientific Research Committee (SAG-TUS-200906-0165). Presented as a poster in Hot Topics in Neonatology 2006, Washington, DC, 2–5 December 2006.     

Intratracheal catheter suction removes the same volume of meconium with less impact on desaturation compared with meconium aspirator in meconium aspiration syndrome

Objective

To evaluate the impact of suction technique on the rate of meconium removal, oxygenation, and hemodynamics in an animal experimental model of meconium aspiration syndrome (MAS).

Methods

MAS was induced in ventilated rabbits using 3.5 ml/kg of 20% human meconium. Tracheal suction with either catheter suction (CS) or meconium aspirator (MA) was performed after meconium instillation. Percentage of meconium collection rate, PaO₂ trends for 2 h after tracheal suction, and acute-phase SpO₂ trends were compared between CS and the other three groups, the tube was withdrawn while meconium was aspirated with an MA, then the trachea was reintubated 5, 10 or 15 s after suctioning of meconium.

Results

Percentage of meconium collection rate and PaO₂ showed no significant differences between groups. The MA group taking 15 s for reintubation after meconium suctioning, showed a significantly lower acute-phase SpO₂ than the CS group (P < 0.05). The time for SpO₂ to return to ≥ 90% was also longer in the MA group taking 15 s for reintubation than in the CS group (P < 0.05).

Conclusion

Intratracheal CS removed the same volume of meconium with less impact on desaturation compared with meconium aspiration in an animal model of MAS. Intratracheal CS may be benefit to remove meconium in non-vigorous infants with meconium-stained amniotic fluid at birth.     

Arterial oxygen saturation profiles in healthy preterm infants

AIM—To construct a reference range of SpO₂ values in healthy preterm infants using a simple data logging device.
METHODS—Thirty three healthy preterm infants were monitored for a continuous period of 4 hours at rest using an Ohmeda Biox 3700 E Pulse Oximeter and an electronic data logger (Rustrack Ranger). Stored data were downloaded and saved as individual files on a personal computer.
RESULTS—The study group median and 5th and 95th percentiles were used to construct a cumulative frequency curve of time against SpO₂ value, representing the normal reference range of SpO₂ profiles in healthy preterm infants.
CONCLUSION—Comparison of an infant''s SpO₂ profile against this curve may be more helpful in guiding supplemental oxygen treatment in that individual than a figure for a mean SPO₂ and its standard deviation.

     

Fructose breath hydrogen tests in infants with chronic non-specific diarrhoea

Clear fluids high in fructose (e.g., apple juice) have been incriminated for symptoms of chronic non-specific diarrhoea (CNSD), in particular in children 1–4 years of age. H₂ breath tests were performed, after ingestion of fructose (1 g/kg), in 15 patients referred with CNSD and 35 controls. All 15 CNSD children (100%) had breath peak H₂ of 20 ppm versus 49% of the 35 controls (P=0.0005). Median peak H₂ in CNSD (90 ppm, range 31–136) was significantly higher than in controls (20 ppm, range 1–139) (P<0.001). Orocoecal transit time in children with positive tests was similar in both groups. Similary, median H₂ increases during the test period had the same distribution. We demonstrated fructose malabsorption in CNSD, but found a great overlap with the control group. Our results strongly discourage the use of fructose breath H₂ tests in children suspected of CNSD. A positive test has no diagnostic value and a negative test has no clinical implications.Conclusion For clinical practice, we suggest a dietary history and a trial of appropriate measures in infants with chronic nonspecific diarrhoea, instead of performing the fructose H₂ breath test.     

Effect of aminophylline on cerebral haemodynamics and oxidative metabolism in premature infants

The effect of aminophylline on cerebral blood volume and oxidative metabolism in newborn infants was investigated with near infrared spectroscopy (NIRS). Thirteen mechanically ventilated premature infants who received aminophylline to facilitate weaning from the respirator were selected. Gestational age ranged between 26 and 34 weeks, postnatal age between 1 and 7 days and birth weight between 760 and 2300 g. A bolus of 6 mg aminophylline/kg body weight was infused within 2 min. NIRS was performed continuously across the head to monitor changes in cerebral blood volume and cytochrome c oxidase. Heart rate, transcutaneous carbon dioxide tension (tcpCO₂) and arterial haemoglobin oxygen saturation (SO₂) were recorded simultaneously. The infusion of aminophylline was associated with an increase in heart rate (median 12, interquartile range 5–20 beats per min,P=0.0004) and a drop in tcpCO₂ (median –0.4, interquartile range –0.1 to –0.5 kPa,P=0.015). Oxygen saturation remained stable (±3%). A decrease in cerebral blood volume was measured with NIRS in 9/13 patients (median –0.15 ml/100g brain tissue, interquartile range +0.08 to –0.28,P=0.10). Oxidized cytochrome c oxidase decreased in 11/13 patients (median –0.27 mol/l, interquartile range –0.19 to –0.44,P=0.01). Our findings demonstrate an immediate step-response of heart rate and tcpCO₂ to aminophylline in premature infants. The simultaneous reduction of cytochrome c oxidase in the brain cannot be explained as a consequence of changes in tcpCO₂ or changes in cerebral blood volume. We therefore speculate that aminophylline interferes directly with cerebral metabolism.     

Influence of nose and mouth leaks on peripheral oxygen saturation during continuous positive airway pressure in neonates

Background

Nose and mouth leaks impair effective pressure transmission during neonatal continuous positive airway pressure (CPAP), but little is known about how these leaks affect physiological parameters. This study investigated the influence of nose leaks and spontaneous mouth opening on peripheral oxygen saturation (SpO₂) and respiratory rate (RR) using nasopharyngeal CPAP.

Methods

In 32 neonates with a gestational age of 30 (24–38) weeks and a birth weight of 1435 (710–2730) g, SpO₂ and RR measurements were taken with and without occlusion of the contralateral nostril in a randomized cross-over trial in 1-minute intervals over a 10-minute period during each condition. Mouth opening and newborn activity were documented.

Results

SpO₂ with open nostril was comparable to that with occluded nostril [93 (78.5–99.5)% vs. 94 (80–100)%, P=0.20]. RR decreased from 51 (26–82)/min to 48 (32–85)/min (P=0.027). In infants with an SpO₂≤93% during open nostril (n=17), SpO₂ increased after nostril occlusion [91 (80–96)% vs. 89.5 (78.5–93)%, P=0.036]. The mouth was open in 78.5% of measurements with open nostril, and in 87.4% of measurements after nostril occlusion (P=0.005). No significant influence of mouth opening or closure on SpO₂ or RR was detected.

Conclusions

In neonates on unilateral nasopharyngeal CPAP with an SpO₂ ≤93%, occlusion of the contralateral nostril significantly increased SpO₂ and reduced RR. The beneficial physiological effects further support using binasal prongs to minimize nose leaks in this population. Future studies should investigate the beneficial effects of reducing mouth leaks when applying CPAP to these infants.     

Renal functional maturation: renal handling of proteins by mature and immature newborns

Renal clearance of creatinine (C_cr), total protein excterion, urinary protein composition and renal clearance of albumin (C_alb) were measured and calculated in male premature and mature infants of gestational age 29–41 weeks and in mature infants 1 and 3 months of age. Total protein excretion decreased slightly but not significantly during maturation. The urinary protein composition changed significantly as the fraction of low molecular weight proteins decreased from 38% at a gestational age of 29–33 weeks to 24% in mature infants aged 3 months, the albumin fraction increased from 39%–46% and the proportion of higher molecular weight proteins increased from 12%–29%, respectively. C_alb decreased from 2.73–0.80 l/min/1.73 m² in the presence of a rise in C_cr, resulting in a significant fall of the ratio C_alb/C_cr from 0.0137 in the youngest prematures to 0.00147 in 3-month-old mature infants.Abbreviations C_cr clearance of craatinine - C_alb clearance of albumin - GA gestational age - GFR glomerular filtration rate - HMW high molecular weight - LMW low molecular weight - A albumin     

Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

Background

There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth.

Aim

To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants.

Study design

Non-experimental study.

Subjects

Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO₂) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis.

Outcome measures

HR and SpO₂ measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth.

Results

Birth SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (P = 0.001 by log-rank test). As for SpO₂ stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P = 0.046).

Conclusions

Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.     

Effective method for screening for respiratory inhibition after crying in infants

Background: In order to establish an effective screening method for respiratory inhibition after crying (RIAC), we prospectively studied the correlations between infant RIAC and perinatal factors. Methods: We monitored infants (n = 141) born from May through July 2009 with polygraphy and evaluated the presence of RIAC and respiratory pause that occurred when feeding was initiated immediately after crying with a decrease in oxygen saturation (SpO₂) to <60%. The infants were screened for increased echogenicity, a cyst in the ganglionic eminence (GE), or a subependymal cyst by cranial ultrasound. Furthermore, we evaluated the correlations between RIAC and perinatal factors. Results: Eleven infants displayed RIAC and 31 experienced respiratory pause during feeding with a decrease in SpO₂ to <60%. There were no significant correlations between RIAC and perinatal factors. Forty infants had ultrasound abnormalities (increased echogenicity in the GE, 26; cyst in the GE, nine; and subependymal cyst, seven). Sensitivity, specificity, and efficiency of abnormal cranial ultrasound findings for RIAC were 1.00, 0.777, and 0.794, respectively. The odds ratio, sensitivity, specificity, and efficiency of the combination of abnormal cranial ultrasound findings and respiratory pause during feeding with a decrease in SpO₂ to <60% and RIAC were 35.9 (P < 0.001), 0.727, 0.931, and 0.915, respectively. Conclusion: The combination of abnormal cranial ultrasound findings and respiratory pause during feeding with a decrease in SpO₂ appears to be an effective method of screening for RIAC.     

Oxygen Saturation Immediately after Birth in Infants Delivered in Tertiary Care Hospital in India

Objective

To study the sequential changes in SpO₂ values in newborns delivered in a teaching hospital in India.

Methods

Full-term infants born by normal vaginal delivery to registered mothers at KLE University Hospital, Belgaum with birth weight more than 2,500 g, no congenital anomalies and who had received only routine care at birth were included in the study. After delivery, newborn infants were placed on a resuscitation trolley under a radiant warmer; the oxygen saturation sensor was attached (Nellcor DURA-Y multisite oxygen sensor) and then connected to the monitor (Planet 55 multiparameter recorder).

Results

The mean (SD) gestational age of infants included in the study was 38.8 (1.1) wk and birth weight was 2,800 (300) g. The median (IQR) oxygen saturation level (SpO₂) at 2 min of age was 69 % (68 %–79 %). The median level of SpO₂ at 90 % and 95 % saturation was attained at 6.5 min and at 11 min of life, respectively.

Conclusions

Infants delivered in resource poor facilities of developing countries take 11 min to reach 95 % saturations after birth but they are within the reference range values of Neonatal Resuscitation Program 2010 guidelines.     

Kidney development in the first year of life in small-for-gestational-age preterm infants

Background: Small-for-gestational-age (SGA) infants have been reported to have a significantly reduced number of nephrons that could be a risk factor for development of hypertension later in life. Objective: To evaluate kidney size prospectively in relation to other anthropometric parameters during the first year of life in SGA babies. Materials and methods: The babies in the study were 31–36 weeks gestational age (GA) at birth and were matched with control preterm infants of similar GA, but appropriate for gestational age (AGA). The SGA infants were further classified as symmetrical and asymmetrical according to the anthropometric parameters. Results: The total number of measurements in symmetrical SGA preterm infants was 324, in asymmetrical SGA preterm infants 295, and in AGA infants 536. In symmetrical SGA preterm infants (31–36 weeks GA) mean kidney length (± SD) of 56±4 mm was significantly different from the controls (58.9±4.6 mm) up to 6 months chronological age (P < 0.05). In the asymmetrical SGA preterm infants, mean kidney length (45.3±4.0 mm) was significantly different from the controls (48.2±4.4 mm) up to 40 weeks corrected age. At 1 year chronological age, all preterm infants (symmetrical and asymmetrical SGA and AGA) had similar mean kidney length (61.6±4.6, 62.8±4.3, and 62.3±4.0 mm, respectively). The ratio of kidney length to crown-to-heel length was similar in all preterm groups. Conclusions: Kidney length in preterm SGA infants (symmetrical and asymmetrical) follows closely the other auxological parameters during the first year of life.     

Prostaglandin E2 administration in infants with ductus-dependent cyanotic congenital heart disease

Prostaglandin E₂ was administered to 22 newborns with ductus-dependent cyanotic congenital heart disease. Twelve patients had pulmonary atresia and ten simple dextrotransposition of the great arteries. Patients were classified into two groups: group 1 (n=11) received prostaglandin E₂ by the intravenous route (dose: 0.01–0.05 g/kg per min); group 2 (n=11) received prostaglandin E₂ by the oral route (dose: 35–65 g/kg per 1–4 h). Treatment lasted for 1–90 days. All infants except one of group 2 showed a significant (>10 Torr) increase in PaO₂ following PGE₂ administration. The mean increase in PaO₂ was higher (P<0.01) in group 1 (21.8±1.7, Torr) than in group 2 (15.8±1.5, Torr). PaO₂ fell significantly (P<0.01) in five patients of group 1 who continued treatment orally with satisfactory (>30 Torr) levels in four of them. Severe side effects were observed only in group 1. The data show that similarly to prostaglandin E₁ infusions, prostaglandin E₂, given i.v. or orally, is useful in the management of infants with ductus-dependent cyanotic congenital heart disease. Oral prostaglandin E₂, administration is less effective than i.v. infusions, but can be used for long-term, therapy being more convenient and causing minimal morbidity.Presented at the IX European Congress of Perinatal Medicine, Dublin, Ireland, 1984     

Target Oxygen Saturation Among Preterm Neonates on Supplemental Oxygen Therapy: A Quality Improvement Study

Objective

To avoid excessive oxygen exposure and achieve target oxygen saturation (SpO₂) within intended range of 88%–95% among preterm neonates on oxygen therapy.

Methods

20 preterm neonates receiving supplemental oxygen in the first week of life were enrolled. The percentage of time per epoch (a consecutive time interval of 10 hours/day) spent by them within the target SpO₂ range was measured in phase 1 followed by implementation of a unit policy on oxygen administration and targeting in phase 2. In phase 3, oxygen saturation histograms constructed from pulse-oximeter data were used as daily feedback to nurses and compliance with oxygen-targeting was measured again.

Results

48 epochs in phase 1 and 69 in phase 3 were analyzed. The mean (SD) percent time spent within target SpO₂ range increased from 65.9% (21.4) to 76.5% (12.6) (P=0.001).

Conclusion

Effective implementation of oxygen targeting policy and feedback using oxygen saturation histograms may improve compliance with oxygen targeting.

     

The effect of in-hospital developmental care on neonatal morbidity,growth and development of preterm Taiwanese infants: A randomized controlled trial

Introduction

Intervention studies of developmental care for preterm infants in Western societies have shown early but unsustainable effects on child outcomes, however only a limited of studies have examined if developmental care interventions produce similar effects in Eastern cultural contexts.

Aims

To examine the effectiveness of in-hospital developmental care on neonatal morbidity, growth and development of preterm infants with very low birth weight (VLBW; birth weight < 1500 g) in Taiwan.

Methods

One hundred and seventy-eight VLBW preterm infants were randomly assigned to the clinical trial during hospitalization at three hospitals in Taiwan; the control group received five sessions of standard child-focused developmental care and the intervention group received five sessions of child- and parent-focused developmental care. Sixty-two normal term infants were also included as a comparison group. Infants were examined for morbidity, growth and developmental outcomes at term age.

Results

At study entry, more infants in the intervention group were twins or multiples than those in the control group (29% vs. 16%, p = 0.05). After adjusting for birth set, the intervention group had lower incidences of stage II–III retinopathy (odds ratio [OR] = 0.34 [95% confidence interval (CI): 0.15–0.79]; p = 0.01) and feeding desaturation (OR = 0.32 [95% CI: 0.10–1.00]; p = 0.05) and had greater daily weight gains (difference = 2.0 g/day [95% CI: 0–4.0 g/day]; p = 0.05) as compared with the control group. However, the intervention and control groups did not differ in any of the neurodevelopmental measures.

Conclusions

In-hospital developmental care has short-term benefits for Taiwanese VLBW preterm infants in reducing the risk of retinopathy and feeding desaturation as well as in enhancing weight gains at term age.     

Blood lead and erythrocyte zinc protoporphyrin in mothers and newborn infants

Blood lead (B-Pb) and erythrocyte zinc protoporphyrin (ZPP) were measured in 78 mothers at delivery and in cord blood from 48 infants living in an area with low atmospheric Pb pollution. Median B-Pb was 35 g/l (range 6–63) in mothers and 20 g/l (range 6–50) in infants (P<0.001), and the values were significantly correlated (r _s=0.73, P<0.0001). Mean B-Pb infant/B-Pb mother ratio was 0.7 (range 0.2–1.4). Mothers had lower ZPP (median 1.6 g/g Hb) than infants (median 2.9) (P<0.0001). ZPP in mothers showed a stronger relation to iron status (serum transferrin, serum ferritin) than to B-Pb (r _s=0.22, P<0.05). B-Pb was correlated to serum iron both in mothers (r _s=0.28, P<0.02) and infants (r _s=0.33, P<0.03). The present B-Pb levels are lower than previously reported in Scandinavia, probably due to the general decline in atmospheric Pb pollution.Abbreviations B-Pb blood lead - Hb haemoglobin - ZPP erythrocyte zinc protoporphyrin