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  • 1
    Online Resource
    Online Resource
    Trends in respiratory management of transferred very preterm infants in the last two decades
    Wiley ; 2021
    In:  Pediatric Pulmonology Vol. 56, No. 8 ( 2021-08), p. 2604-2610
    Details
    In: Pediatric Pulmonology, Wiley, Vol. 56, No. 8 ( 2021-08), p. 2604-2610
    Abstract: Among infants needing urgent transfer after birth, very preterm infants are a high‐risk sub‐group requiring special attention. This study aimed to assess trends in early respiratory management in a large series of very preterm infants undergoing postnatal transfer. Methods Trends in patient characteristics and early respiratory management were assessed in 798 very preterm infants who were transferred by the Eastern Veneto Neonatal Emergency Transport Service in 2000–2019. Trends were analyzed using joinpoint regression analysis and summarized as annual percentage changes (APCs). Results Proportion of neonates with birth weight less than 1 kg decreased from 33% to 16% (APC −3.82%). Use of nasal‐continuous‐positive‐airway pressure increased (at call: APC 15.39%; during transfer: APC 15.60%), while use of self‐inflating bag (at call: APC −12.09%), oxygen therapy (at call: APC −13.00%; during transfer: APC −23.77%) and mechanical ventilation (at call: APC −2.71%; during transfer: APC −2.99%) decreased. Use of oxygen concentrations at 21% increased (at call: APC 6.26%; during transfer: APC 7.14%), while oxygen concentrations above 40% decreased (at call: APC −5.73%; at transfer APC −8.89%). Surfactant administration at call increased (APC 3%–10%), while surfactant administration when arriving at referring hospital remained around 7‐11% (APC 2.55%). Conclusion Relevant trends toward “gentle” approaches in early respiratory management of very preterm infants undergoing postnatal transfer occurred during the last twenty years. In addition, the proportion of transferred extremely low birth weight infants halved. Clinicians and stakeholders should consider such information when allocating assets to both hospitals and transfer services and planning regional perinatal programs.
    Type of Medium: Online Resource
    ISSN: 8755-6863 , 1099-0496
    URL: Issue
    URL: Article
    DOI: 10.1002/ppul.v56.8
    DOI: 10.1002/ppul.25532
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1491904-7
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  • 2
    Online Resource
    Online Resource
    Trends in neonatal emergency transport in the last two decades
    Springer Science and Business Media LLC ; 2021
    In:  European Journal of Pediatrics Vol. 180, No. 2 ( 2021-02), p. 635-641
    Details
    In: European Journal of Pediatrics, Springer Science and Business Media LLC, Vol. 180, No. 2 ( 2021-02), p. 635-641
    Type of Medium: Online Resource
    ISSN: 0340-6199 , 1432-1076
    URL: Article
    DOI: 10.1007/s00431-020-03908-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2647723-3
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  • 3
    Online Resource
    Online Resource
    Laryngeal mask airway in neonatal stabilization and transport: a retrospective study
    Springer Science and Business Media LLC ; 2023
    In:  European Journal of Pediatrics
    Details
    In: European Journal of Pediatrics, Springer Science and Business Media LLC
    Abstract: Laryngeal mask airway (LMA) may be considered by health caregivers of level I–II hospitals for neonatal resuscitation and stabilization before and during interhospital care, but literature provides little information on this aspect. This study reviewed the use of LMA during stabilization and transport in a large series of neonates. This is a retrospective study evaluating the use of LMA in infants who underwent emergency transport by the Eastern Veneto Neonatal Emergency Transport Service between January 2003 and December 2021. All data were obtained from transport registry, transport forms, and hospital charts. In total, 64/3252 transferred neonates (2%) received positive pressure ventilation with an LMA, with increasing trend over time ( p  = 0.001). Most of these neonates were transferred after birth (97%), due to a respiratory or neurologic disease (95%). LMA was used before the transport ( n  = 60), during the transport ( n  = 1), or both ( n  = 3). No device-related adverse effects were recorded. Sixty-one neonates (95%) survived and were discharged/transferred from the receiving center. Conclusion : In a large series of transferred neonates, LMA use during stabilization and transport was rare but increasing over time, and showed some heterogeneity among referring centers. In our series, LMA was safe and lifesaving in “cannot intubate, cannot oxygenate” situations. Future prospective, multicenter research may provide detailed insights on LMA use in neonates needing postnatal transport. What is Known: •  A supraglottic airway device may be used as an alternative to face mask and endotracheal tube during neonatal resuscitation. •  The laryngeal mask may be considered by health caregivers of low-level hospitals with limited exposure on airway management, but literature provides little information on this aspect. What is New: •  In a large series of transferred neonates, laryngeal mask use was rare but increasing over time, and showed some heterogeneity among referring centers. •  The laryngeal mask was safe and lifesaving in “cannot intubate, cannot oxygenate” situations.
    Type of Medium: Online Resource
    ISSN: 1432-1076
    URL: Article
    DOI: 10.1007/s00431-023-05089-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2647723-3
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  • 4
    Online Resource
    Online Resource
    Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study
    BMJ ; 2021
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition Vol. 106, No. 6 ( 2021-11), p. 572-577
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 106, No. 6 ( 2021-11), p. 572-577
    Abstract: The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed. Objective To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth. Study design and setting Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals. Participants Infants with estimated birth weight 〈 1500 g and/or gestational age 〈 30 +6 weeks. Intervention Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room. Primary outcome Proportion of normothermia at NICU admission (axillary temperature 36.5°C–37.5°C). Results At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C–36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01). Conclusions In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge. Trial registration number NCT03844204
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2020-320567
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2188490-0
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  • 5
    Online Resource
    Online Resource
    A bullous purpura triggered by warming in a newborn with congenital cytomegalovirus infection
    Medknow ; 2022
    In:  Journal of Clinical Neonatology Vol. 11, No. 1 ( 2022), p. 58-
    Details
    In: Journal of Clinical Neonatology, Medknow, Vol. 11, No. 1 ( 2022), p. 58-
    Type of Medium: Online Resource
    ISSN: 2249-4847
    URL: Article
    DOI: 10.4103/jcn.jcn_37_21
    Language: English
    Publisher: Medknow
    Publication Date: 2022
    detail.hit.zdb_id: 2713634-6
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  • 6
    Online Resource
    Online Resource
    A Simulation Competition on Neonatal Resuscitation as a New Educational Tool for Pediatric Residents
    MDPI AG ; 2023
    In:  Children Vol. 10, No. 10 ( 2023-09-28), p. 1621-
    Details
    In: Children, MDPI AG, Vol. 10, No. 10 ( 2023-09-28), p. 1621-
    Abstract: Background: Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants’ perceptions of the educational experience. Methods: Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience. Results: 81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing. Conclusions: Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions.
    Type of Medium: Online Resource
    ISSN: 2227-9067
    URL: Article
    DOI: 10.3390/children10101621
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2732685-8
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  • 7
    Online Resource
    Online Resource
    Table_1.pdf
    Frontiers Media SA ; 2022
    In:  Frontiers in Neuroscience Vol. 16 ( 2022-7-13)
    Details
    In: Frontiers in Neuroscience, Frontiers Media SA, Vol. 16 ( 2022-7-13)
    Abstract: Tumor heterogeneity poses major clinical challenges in high-grade gliomas (HGGs). Quantitative radiomic analysis with spatial tumor habitat clustering represents an innovative, non-invasive approach to represent and quantify tumor microenvironment heterogeneity. To date, habitat imaging has been applied mainly on conventional magnetic resonance imaging (MRI), although virtually extendible to any imaging modality, including advanced MRI techniques such as perfusion and diffusion MRI as well as positron emission tomography (PET) imaging. Objectives This study aims to evaluate an innovative PET and MRI approach for assessing hypoxia, perfusion, and tissue diffusion in HGGs and derive a combined map for clustering of intra-tumor heterogeneity. Materials and Methods Seventeen patients harboring HGGs underwent a pre-operative acquisition of MR perfusion (PWI), Diffusion (dMRI) and 18 F-labeled fluoroazomycinarabinoside ( 18 F-FAZA) PET imaging to evaluate tumor vascularization, cellularity, and hypoxia, respectively. Tumor volumes were segmented on fluid-attenuated inversion recovery (FLAIR) and T1 post-contrast images, and voxel-wise clustering of each quantitative imaging map identified eight combined PET and physiologic MRI habitats. Habitats’ spatial distribution, quantitative features and histopathological characteristics were analyzed. Results A highly reproducible distribution pattern of the clusters was observed among different cases, particularly with respect to morphological landmarks as the necrotic core, contrast-enhancing vital tumor, and peritumoral infiltration and edema, providing valuable supplementary information to conventional imaging. A preliminary analysis, performed on stereotactic bioptic samples where exact intracranial coordinates were available, identified a reliable correlation between the expected microenvironment of the different spatial habitats and the actual histopathological features. A trend toward a higher representation of the most aggressive clusters in WHO (World Health Organization) grade IV compared to WHO III was observed. Conclusion Preliminary findings demonstrated high reproducibility of the PET and MRI hypoxia, perfusion, and tissue diffusion spatial habitat maps and correlation with disease-specific histopathological features.
    Type of Medium: Online Resource
    ISSN: 1662-453X
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fnins.2022.885291
    DOI: 10.3389/fnins.2022.885291.s001
    DOI: 10.3389/fnins.2022.885291.s002
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2411902-7
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  • 8
    Online Resource
    Online Resource
    Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial
    Springer Science and Business Media LLC ; 2021
    In:  European Journal of Pediatrics Vol. 180, No. 1 ( 2021-01), p. 247-252
    Details
    In: European Journal of Pediatrics, Springer Science and Business Media LLC, Vol. 180, No. 1 ( 2021-01), p. 247-252
    Abstract: Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13 s, 95% confidence interval 8 to 18 s; p   〈  0.0001) and neonatologists (mean difference 12 s, 95% confidence interval 8 to 16 s; p   〈  0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference − 1 s, 95% confidence interval − 7 to 6 s; p  = 0.85). Conclusions : Performing immediate laryngoscopy with intubation and suctioning was associated with longer—but not clinically relevant—time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted. Registration : clinicaltrial.gov NCT04076189. What is Known: • Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial. • Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown. What is New: • Performing immediate ventilation without intubation was associated with shorter—but not clinically relevant—time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model. • Further studies in a clinical setting are warranted.
    Type of Medium: Online Resource
    ISSN: 0340-6199 , 1432-1076
    URL: Article
    DOI: 10.1007/s00431-020-03759-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 9
    Online Resource
    Online Resource
    MYD88 L265P mutation and interleukin‐10 detection in cerebrospinal fluid are highly specific discriminating markers in patients with primary central nervous system lymphoma: results from a prospective study
    Wiley ; 2021
    In:  British Journal of Haematology Vol. 193, No. 3 ( 2021-05), p. 497-505
    Details
    In: British Journal of Haematology, Wiley, Vol. 193, No. 3 ( 2021-05), p. 497-505
    Abstract: Reliable biomarkers are needed to avoid diagnostic delay and its devastating effects in patients with primary central nervous system (CNS) lymphoma (PCNSL). We analysed the discriminating sensitivity and specificity of myeloid differentiation primary response (88) ( MYD88 ) L265P mutation (mut‐ MYD88 ) and interleukin‐10 (IL‐10) in cerebrospinal fluid (CSF) of both patients with newly diagnosed ( n  = 36) and relapsed ( n  = 27) PCNSL and 162 controls (118 CNS disorders and 44 extra‐CNS lymphomas). The concordance of MYD88 mutational status between tumour tissue and CSF sample and the source of ILs in PCNSL tissues were also investigated. Mut‐ MYD88 was assessed by TaqMan‐based polymerase chain reaction. IL‐6 and IL‐10 messenger RNA (mRNA) was assessed on PCNSL biopsies using RNAscope technology. IL levels in CSF were assessed by enzyme‐linked immunosorbent assay. Mut‐ MYD88 was detected in 15/17 (88%) PCNSL biopsies, with an 82% concordance in paired tissue‐CSF samples. IL‐10 mRNA was detected in lymphomatous B cells in most PCNSL; expression of IL‐6 transcripts was negligible. In CSF samples, mut‐ MYD88 and high IL‐10 levels were detected, respectively, in 72% and 88% of patients with newly diagnosed PCNSL and in 1% of controls; conversely, IL‐6 showed a low discriminating sensitivity and specificity. Combined analysis of MYD88 and IL‐10 exhibits a sensitivity and specificity to distinguish PCNSL of 94% and 98% respectively. Similar figures were recorded in patients with relapsed PCNSL. In conclusion, high detection rates of mut‐ MYD88 and IL‐10 in CSF reflect, respectively, the MYD88 mutational status and synthesis of this IL in PCNSL tissue. These biomarkers exhibit a very high sensitivity and specificity in detecting PCNSL both at initial diagnosis and relapse. Implications of these findings in patients with lesions unsuitable for biopsy deserve to be investigated.
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
    URL: Article
    DOI: 10.1111/bjh.v193.3
    DOI: 10.1111/bjh.17357
    RVK:
    XA 34100
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1475751-5
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  • 10
    Online Resource
    Online Resource
    Surfactant Treatment of Late Preterm Infants during Emergency Transport: A Retrospective, Observational Study
    S. Karger AG ; 2021
    In:  Neonatology Vol. 118, No. 5 ( 2021), p. 617-623
    Details
    In: Neonatology, S. Karger AG, Vol. 118, No. 5 ( 2021), p. 617-623
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 In late preterm infants born in nontertiary hospitals, the occurrence of respiratory distress syndrome requires postnatal transport. This study aimed to investigate the impact of the timing of surfactant administration in late preterm infants needing postnatal transport. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This is a retrospective study evaluating surfactant administration in late preterm infants during emergency transports by the Eastern Veneto Neonatal Emergency Transport Service between January 2005 and December 2019. The outcome measures included short-term clinical complications, stabilization time, oxygen concentration, duration of mechanical ventilation and noninvasive respiratory support, length of hospital stay, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Surfactant was administered to 155/303 neonates (51.1%) at 3 different time points: at a referring hospital (50 neonates), when the transport team arrived (25 neonates), or at a referral hospital (80 neonates). Stabilization time was longer in neonates receiving surfactant by the transport team (adjusted mean difference 17 min, 95% confidence interval, 4–29 min; 〈 i 〉 p 〈 /i 〉 = 0.01). Decrease in oxygen concentrations during the transport was larger in neonates receiving surfactant at a referring hospital (adjusted mean difference −11%, 95% confidence interval, −15 to −3%; 〈 i 〉 p 〈 /i 〉 = 0.01). The other outcome measures were not statistically different according to the timing of surfactant administration. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In late preterm infants with respiratory distress needing postnatal transfer, stabilization time was longer when the first surfactant was administered by the transport team, but such delay did not affect safety and clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000518986
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 2403535-X
    SSG: 12
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