Erstversorgung von Neugeborenen

Approximately 3%–6% of all newborn infants require some form of resuscitation at birth, making neonatal resuscitation one of the commonest medical interventions. An internationally agreed consensus statement and various guidelines advise how newborn infants should be resuscitated and suggest equipment to use. The aim of this study was to compare the current standard of neonatal resuscitation in Austria with the neonatal resuscitation guidelines published in 2005. A questionnaire was sent to Austrian neonatal units with delivery rooms. The questionnaire evaluated the use of positive pressure ventilation devices, pulse oximetry, laryngeal mask, oral (Guedel) airway, oxygen blenders, use of supplementary oxygen in term infants, CO₂ detectors and polyethylene wrapping for infants ≤ 28 weeks. All 20 neonatal units contacted answered the questionnaire. The initial oxygen concentration during resuscitation of term infants ranged between 21% and 100%. A total of 17 (85%) departments used oxygen blenders, the others a flow meter. Pulse oximetry was used in 20 (100%) departments, nine (45%) used a self-inflating-bag and a T-piece device. Two departments used either the self-inflating or the T-piece device and none used the flow-inflating bag. An oral airway (Guedel) was used in 10 (50%) and a laryngeal mask in eight (40%) departments. CO₂ detectors were in use in six (30%) and polyethylene wrapping in 11 (55%) departments. This survey shows that, in line with the international trend, a wide-ranging variety of equipment is used also in Austria, reflecting the lack of data on neonatal resuscitation.     

Intra- and extrauterine maturation of amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks of gestation

OBJECTIVE: To prospectively investigate the longitudinal changes of amplitude-integrated electroencephalographic (aEEG) activity in preterm infants <30 weeks gestational age (GA). METHODS: Infants (GA <30 weeks) without evidence of neurological abnormalities had weekly aEEG recordings performed. The relative duration of the three aEEG patterns (discontinuous low voltage, discontinuous high voltage and continuous) was determined and the influence of GA and postnatal age (PNA) on the occurrence of each pattern was assessed. RESULTS: Ninety-eight infants (median GA 26 weeks; range 23-29 weeks) were studied. With higher GA (OR 1.68, 95% CI 1.33-2.13) and PNA (OR 1.91, 95% CI 1.53-2.38), the likelihood for the occurrence of continuous activity increased. The discontinuous low-voltage pattern was less likely to occur with increasing GA (OR 0.68, 95% CI 0.55-0.83) and PNA (OR 0.70, 95% CI 0.61-0.81). CONCLUSION: Maturation of aEEG activity in preterm infants is influenced by both GA and PNA.     

Early life serum neurofilament dynamics predict neurodevelopmental outcome of preterm infants

Journal of Neurology - To determine whether neurofilament light chain (NfL), a promising serum and cerebrospinal fluid (CSF) biomarker of neuroaxonal damage, predicts functional outcome in preterm...     

Amplitude-integrated EEG pattern predicts further outcome in preterm infants

Changes in EEG background activity are powerful but nonspecific markers of brain dysfunction. Early EEG and amplitude-integrated EEG (aEEG) pattern predict further neurodevelopmental outcome in term infants; however, sufficient data for prognostic value of aEEG in preterm infants are not available so far. The aim of the study was to evaluate whether aEEG predicts further outcome and to compare it to cerebral ultrasound assessment. In 143 preterm infants, aEEG within the first 2 wk of life and outcome data at 3 y of age (Bayley Scales) could be obtained.aEEG was classified into a graded score according to background activity, appearance of sleep-wake cycling, and occurrence of seizure activity. In preterm infants, aEEG was significantly associated with further outcome. Specificity was 73% for assessment within the first and increased to 95% in the second week of life, whereas sensitivity stayed nearly the same 87% (first week) to 83% (second week). Cerebral ultrasound showed a specificity of 86% within the first and second week, sensitivity also stayed nearly the same (74 and 75%). aEEG has a predictive value for later outcome in preterm infants and can be used as an early prognostic tool.     

Impact of low-grade intraventricular hemorrhage on long-term neurodevelopmental outcome in preterm infants

Purpose

Despite a decreasing incidence, intraventricular hemorrhage (IVH) remains a point of major concern in neonatology due to its association to adverse neurodevelopmental outcome (NDO). Aim of this study was to compare outcome of preterm infants with different grades of IVH born below 32?weeks of gestational age (GA) with outcome of controls without IVH and to especially evaluate the influence of low grade IVH on NDO.

Methods

Four hundred seventy-one preterm infants with a GA below 32?weeks were admitted to our neonatal intensive care unit between 1994 and 2005 and included into analysis.

Results

IVH patients showed significantly lower mean psychomotor and mental developmental indices and a significantly higher percentage of cerebral palsy and visual impairment. Results of IVH patients born below 28?weeks of GA were significantly worse than results of IVH patients born at or above 28?weeks of GA. In all parameters, an increase of abnormal results with increasing grade of IVH could be observed; even patients with low-grade IVH (grades I and II) showed higher percentages of impairment compared to controls without any IVH.

Conclusion

Even low-grade IVH has an significant impact on neurodevelopmental outcome of preterm patients and gestational age influences the impact of intraventricular hemorrhage on neurodevelopmental outcome.