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  • 1
    Online Resource
    Online Resource
    Variability in the Assessment of ‘Adequate’ Chest Excursion during Simulated Neonatal Resuscitation
    S. Karger AG ; 2011
    In:  Neonatology Vol. 100, No. 1 ( 2011), p. 99-104
    Details
    In: Neonatology, S. Karger AG, Vol. 100, No. 1 ( 2011), p. 99-104
    Abstract: 〈 i 〉 Background: 〈 /i 〉 International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing ‘adequate’ chest excursion lacks objectivity. 〈 i 〉 Aim: 〈 /i 〉 It was the aim of this study to test the accuracy in the assessment of ‘adequate’ chest excursion by measuring intra- and inter-observer variability of participants during simulated neonatal resuscitation. 〈 i 〉 Methods: 〈 /i 〉 Thirty-seven staff members (8 neonatologists, 8 registrars, 21 nurses) of the Neonatal Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands, ventilated 2 different intubated, leak-free manikins at 2 attempts, each with a different compliance. Blinded to the manometer, participants could change the peak inflation pressure until chest movement was adequate according to their perception. Inflating pressures were recorded. 〈 i 〉 Results: 〈 /i 〉 According to the participants, a median (interquartile range) pressure of 18 cm H 〈 sub 〉 2 〈 /sub 〉 O (16–22) at the first and 18 cm H 〈 sub 〉 2 〈 /sub 〉 O (16–25) at the second attempt were needed to reach adequate chest excursion in the Laerdal manikin. The HAL manikin needed 26 cm H 〈 sub 〉 2 〈 /sub 〉 O (19–31) and 24 cm H 〈 sub 〉 2 〈 /sub 〉 O (22–33), respectively. The inter-observer coefficient of variance was 30% with the Laerdal manikin at both attempts, and 35 and 40% with the HAL manikin, respectively. The intra-observer coefficient of variance was 15% (8–23) with the Laerdal and 13% (9–20) with the HAL manikin. In both manikins and attempts, no significant differences in pressures and variances of pressures between the 3 groups were found. 〈 i 〉 Conclusion: 〈 /i 〉 ‘Adequate’ chest excursion is a subjective parameter for guidance of appropriate ventilation during neonatal resuscitation.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000322009
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 2403535-X
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  • 2
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    Online Resource
    The Relationship between Oxidative Stress, Intermittent Hypoxemia, and Hospital Duration in Moderate Preterm Infants
    S. Karger AG ; 2020
    In:  Neonatology Vol. 117, No. 5 ( 2020), p. 577-583
    Details
    In: Neonatology, S. Karger AG, Vol. 117, No. 5 ( 2020), p. 577-583
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Lipid peroxidation products are present following oxidation of polyunsaturated fatty acids in the eye, brain, and various cell membranes. Elevated levels of lipid peroxidation products and increased intermittent hypoxemia (IH) events have been associated with adverse outcomes in extremely preterm infants. The moderate preterm newborn has a still-developing oxidant defense system and immature respiratory control, but little is known about lipid peroxidation levels and IH in this larger and more common preterm population. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To determine the association between oxidative stress and IH in moderate preterm infants. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 Oxygen saturation was continuously monitored in 51 moderate preterm infants (i.e., 31 + 0/7 to 33 + 6/7 weeks’ gestation). Urine samples were collected at the end of the first and second weeks of life. Samples were analyzed for total lipid peroxidation products (neurofurans, isofurans, neuroprostanes, isoprostanes, and di-homo-isofurans). 〈 b 〉 〈 i 〉 Result: 〈 /i 〉 〈 /b 〉 At week 1, there was a correlation between increased IH frequency and neurofurans ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.04) and di-homo-isofurans ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.003). At week 2, there was no correlation between IH and lipid peroxidation markers. Ele­vations in neurofurans, isofurans, neuroprostanes, and di-homo-isofurans in the first and/or second week of life were associated with a longer stay in hospital. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Elevations in lipid peroxidation biomarkers in moderate preterm infants during their first weeks of life are associated with a higher frequency of IH and prolonged hospitalization.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000509038
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 2403535-X
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  • 3
    Online Resource
    Online Resource
    Effect of Dexamethasone on Tracheobronchial Aspirate Fluid Cytology and Pulmonary Mechanics in Preterm Infants
    S. Karger AG ; 2004
    In:  Pharmacology Vol. 71, No. 3 ( 2004), p. 113-119
    Details
    In: Pharmacology, S. Karger AG, Vol. 71, No. 3 ( 2004), p. 113-119
    Abstract: The changes induced on respiratory mechanics and on tracheobronchial aspirate fluid (TAF) cytology by dexamethasone courses started at two different postnatal ages in preterm infants at risk of chronic lung disease (CLD) were reported in this clinical trial designed in two phases. The first phase of the study included 20 neonates with birth weight ≤1,250 g and gestational age ≤32 weeks, who were oxygen and ventilator dependent on the 10th day of life. They were randomly assigned to the moderately early dexamethasone (MED) group or to the control group. The second phase of the study included 20 neonates with the same characteristics, oxygen and ventilator dependent on the 4th day of life, randomly assigned to the early dexamethasone (ED) group or to the control group. Both treated groups received dexamethasone intravenously for 7 days (0.5 mg/kg/day for the first 3 days, 0.25 mg/kg/day for the next 3 days, and 0.125 mg/kg/day for the last day of treatment). The control groups received no steroid treatment. A significantly lower absolute cell count and percentage of neutrophils (PMN) in the TAF and significantly higher dynamic lung compliance (Cdyn) values were observed in both the MED treated compared to the untreated infants and the ED treated infants compared to the control group. Moreover these changes were more precocious in the ED Group compared to the MED Group. Our study suggests that dexamethasone could be more efficacious in reducing effects of ventilator-induced lung injury in preterm infants at high risk of CLD when started earlier.
    Type of Medium: Online Resource
    ISSN: 0031-7012 , 1423-0313
    URL: Article
    DOI: 10.1159/000077444
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2004
    detail.hit.zdb_id: 1483550-2
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  • 4
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    Online Resource
    A Narrative Review of the Rationale for Conducting Neonatal Emergency Studies with a Waived or Deferred Consent Approach
    S. Karger AG ; 2023
    In:  Neonatology Vol. 120, No. 3 ( 2023), p. 344-352
    Details
    In: Neonatology, S. Karger AG, Vol. 120, No. 3 ( 2023), p. 344-352
    Abstract: Emergency research studies are high-stakes studies that are usually performed on the sickest patients, where many patients or guardians have no opportunity to provide full informed consent prior to participation. Many emergency studies self-select healthier patients who can be informed ahead of time about the study process. Unfortunately, results from such participants may not be informative for the future care of sicker patients. This inevitably creates waste and perpetuates uninformed care and continued harm to future patients. The waiver or deferred consent process is an alternative model that may be used to enroll sick patients who are unable to give prospective consent to participate in a study. However, this process generates vastly different stakeholder views which have the potential to create irreversible impediments to research and knowledge. In studies involving newborn infants, consent must be sought from a parent or guardian, and this adds another layer of complexity to already fraught situations if the infant is very sick. In this manuscript, we discuss reasons why consent waiver or deferred consent processes are vital for some types of neonatal research, especially those occurring at and around the time of birth. We provide a framework for conducting neonatal emergency research under consent waiver that will ensure the patient’s best interests without compromising ethical, beneficial, and informative knowledge acquisition to improve the future care of sick newborn infants.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000530257
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 2403535-X
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  • 5
    Online Resource
    Online Resource
    Differential Hemodynamic Effects of Levosimendan in a Porcine Model of Neonatal Hypoxia-Reoxygenation
    S. Karger AG ; 2012
    In:  Neonatology Vol. 101, No. 3 ( 2012), p. 192-200
    Details
    In: Neonatology, S. Karger AG, Vol. 101, No. 3 ( 2012), p. 192-200
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Neonatal asphyxia can be complicated by myocardial dysfunction with secondary alterations in pulmonary and regional hemodynamics. Levosimendan is a calcium-sensitizing inotrope that may support cardiac output, but little is known regarding its differential hemodynamic effects in asphyxiated neonates. 〈 i 〉 Methods: 〈 /i 〉 Mixed breed piglets (1–4 days old, weight 1.6–2.3 kg) were acutely instrumented. Normocapnic alveolar hypoxia (10–15% oxygen) was induced for 2 h, followed by reoxygenation with 100% (1 h) and then 21% oxygen (3 h). At 2 h of reoxygenation, after volume loading (Ringer’s lactate 10 ml/kg), either levosimendan (0.1 or 0.2 µg/kg/min) or D 〈 sub 〉 5 〈 /sub 〉 W (placebo) was infused for 2 h in a blinded, block-randomized fashion (n = 7–8/group). The systemic, pulmonary and regional (carotid, superior mesenteric and renal) hemodynamics were compared. 〈 i 〉 Results: 〈 /i 〉 At 0.1 and 0.2 µg/kg/min, levosimendan significantly increased cardiac output (121 and 123% of pretreatment, respectively) and heart rate, and decreased systemic vascular resistance without causing hypotension. Pulmonary arterial pressure and estimated pulmonary vascular resistance were significantly increased from pretreatment baseline in 0.1 but not 0.2 µg/kg/min levosimendan. Levosimendan infusion had no effects on regional hemodynamics. Myocardial efficiency but not oxygen consumption increased with 0.1 µg/kg/min levosimendan without significant effects on plasma troponin and myocardial lactate levels. 〈 i 〉 Conclusions: 〈 /i 〉 In newborn piglets following hypoxia-reoxygenation injury, levosimendan improves cardiac output but has no marked effects in carotid, superior mesenteric and renal perfusion. It appears that various doses of levosimendan increase the cardiac output through different mechanisms. Further investigations are needed to examine the effectiveness of levosimendan as a cardiovascular supportive therapy either alone or in conjunction with other inotropes in asphyxiated neonates.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000329825
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
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  • 6
    Online Resource
    Online Resource
    Ischemic Intestinal Injury during Cardiopulmonary Bypass Does Not Show an Association with Neutrophil Activation
    S. Karger AG ; 2009
    In:  European Surgical Research Vol. 42, No. 1 ( 2009), p. 59-69
    Details
    In: European Surgical Research, S. Karger AG, Vol. 42, No. 1 ( 2009), p. 59-69
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Neutrophil activation and tissue sequestration are crucial events in intestinal ischemia-reperfusion injury, but their role in the gut wall after clinical cardiopulmonary bypass (CPB) remains unclear. We tested whether local post-CPB inflammatory response in the gut wall would be associated with intestinal mucosal perfusion. 〈 i 〉 Methods: 〈 /i 〉 Twenty pigs underwent 60 min of aortic clamping and 75 min of normothermic perfusion. Intestinal biopsies were taken after 120 min of reperfusion. Based on ileal myeloperoxidase activity (MPO), the animals were divided into 2 groups, CPB-induced increase in MPO (MPO+) versus no such increase (MPO–), for comparison of the parameters that measure gut mucosal perfusion. Ileal p 〈 sub 〉 CO 〈 /sub 〉 〈 sub 〉 〈 sub 〉 2 〈 /sub 〉 〈 /sub 〉 and intramucosal pH were determined, and arterial gases were analyzed. Additionally, several hemodynamic parameters and blood thrombin-antithrombin complexes (TAT) were measured. 〈 i 〉 Results: 〈 /i 〉 Myocyte degeneration, endothelial activation and vasculitis were more pronounced in the MPO+ group (p 〈 0.05), while the MPO– group showed significantly increased pi 〈 sub 〉 CO 〈 /sub 〉 〈 sub 〉 〈 sub 〉 2 〈 /sub 〉 〈 /sub 〉 and lower mucosal pH values during reperfusion. Hemodynamics and TAT levels did not differ between the groups. 〈 i 〉 Conclusion: 〈 /i 〉 Tissue sequestration of neutrophils was poorly associated with perturbed mucosal perfusion after CPB. Mechanisms of gut wall injury after a low-flow/reperfusion setting can differ from those in reperfusion injury after total ischemia.
    Type of Medium: Online Resource
    ISSN: 0014-312X , 1421-9921
    URL: Article
    DOI: 10.1159/000169983
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1468505-X
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  • 7
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    Online Resource
    Environmental Exposure during Pregnancy: Influence on Prenatal Development and Early Life: A Comprehensive Review
    S. Karger AG ; 2021
    In:  Fetal Diagnosis and Therapy Vol. 48, No. 4 ( 2021), p. 245-257
    Details
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 48, No. 4 ( 2021), p. 245-257
    Abstract: Preconception and prenatal exposure to environmental contaminants may affect future health. Pregnancy and early life are critical sensitive windows of susceptibility. The aim of this review was to summarize current evidence on the toxic effects of environment exposure during pregnancy, the neonatal period, and childhood. Alcohol use is related to foetal alcohol spectrum disorders, foetal alcohol syndrome being its most extreme form. Smoking is associated with placental abnormalities, preterm birth, stillbirth, or impaired growth and development, as well as with intellectual impairment, obesity, and cardiovascular diseases later in life. Negative birth outcomes have been linked to the use of drugs of abuse. Pregnant and lactating women are exposed to endocrine-disrupting chemicals and heavy metals present in foodstuffs, which may alter hormones in the body. Prenatal exposure to these compounds has been associated with pre-eclampsia and intrauterine growth restriction, preterm birth, and thyroid function. Metals can accumulate in the placenta, causing foetal growth restriction. Evidence on the effects of air pollutants on pregnancy is constantly growing, for example, preterm birth, foetal growth restriction, increased uterine vascular resistance, impaired placental vascularization, increased gestational diabetes, and reduced telomere length. The advantages of breastfeeding outweigh any risks from contaminants. However, it is important to assess health outcomes of toxic exposures via breastfeeding. Initial studies suggest an association between pre-eclampsia and environmental noise, particularly with early-onset pre-eclampsia. There is rising evidence of the negative effects of environmental contaminants following exposure during pregnancy and breastfeeding, which should be considered a major public health issue.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    URL: Article
    DOI: 10.1159/000514884
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1482292-1
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  • 8
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    Online Resource
    Defining Longer-Term Outcomes in an Ovine Model of Moderate Perinatal Hypoxia-Ischemia
    S. Karger AG ; 2022
    In:  Developmental Neuroscience Vol. 44, No. 4-5 ( 2022), p. 277-294
    Details
    In: Developmental Neuroscience, S. Karger AG, Vol. 44, No. 4-5 ( 2022), p. 277-294
    Abstract: Hypoxic-ischemic encephalopathy (HIE) is the leading cause of neonatal morbidity and mortality worldwide. Approximately 1 million infants born with HIE each year survive with cerebral palsy and/or serious cognitive disabilities. While infants born with mild and severe HIE frequently result in predictable outcomes, infants born with moderate HIE exhibit variable outcomes that are highly unpredictable. Here, we describe an umbilical cord occlusion (UCO) model of moderate HIE with a 6-day follow-up. Near-term lambs ( 〈 i 〉 n 〈 /i 〉 = 27) were resuscitated after the induction of 5 min of asystole. Following recovery, lambs were assessed to define neurodevelopmental outcomes. At the end of this period, lambs were euthanized, and brains were harvested for histological analysis. Compared with prior models that typically follow lambs for 3 days, the observation of neurobehavioral outcomes for 6 days enabled identification of animals that recover significant neurological function. Approximately 35% of lambs exhibited severe motor deficits throughout the entirety of the 6-day course and, in the most severely affected lambs, developed spastic diparesis similar to that observed in infants who survive severe neonatal HIE (severe, UCOs). Importantly, and similar to outcomes in human neonates, while initially developing significant acidosis and encephalopathy, the remainder of the lambs in this model recovered normal motor activity and exhibited normal neurodevelopmental outcomes by 6 days of life (improved, UCOi). The UCOs group exhibited gliosis and inflammation in both white and gray matters, oligodendrocyte loss, neuronal loss, and cellular death in the hippocampus and cingulate cortex. While the UCOi group exhibited more cellular death and gliosis in the parasagittal cortex, they demonstrated more preserved white matter markers, along with reduced markers of inflammation and lower cellular death and neuronal loss in Ca3 of the hippocampus compared with UCOs lambs. Our large animal model of moderate HIE with prolonged follow-up will help further define pathophysiologic drivers of brain injury while enabling identification of predictive biomarkers that correlate with disease outcomes and ultimately help support development of therapeutic approaches to this challenging clinical scenario.
    Type of Medium: Online Resource
    ISSN: 0378-5866 , 1421-9859
    URL: Article
    DOI: 10.1159/000525150
    RVK:
    XG 8817
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1482201-5
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  • 9
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    〈b〉NET〈/b〉work 〈b〉M〈/b〉eta-analysis Of 〈b〉T〈/b〉rials of 〈b〉I〈/b〉nitial 〈b〉O〈/b〉xygen in preterm 〈b〉N〈/b〉ewborns (NETMOTION): A Protocol for Systematic Review and Individual Participant Data Network Meta-Analysis of Preterm Infants <32 Weeks’ Gestation Randomized to Initial Oxygen Concentration for Resuscitation
    S. Karger AG ; 2022
    In:  Neonatology Vol. 119, No. 4 ( 2022), p. 517-524
    Details
    In: Neonatology, S. Karger AG, Vol. 119, No. 4 ( 2022), p. 517-524
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Internationally recognized guidelines recommend the judicious use of low oxygen (21–30%), titrated to peripheral oxygen saturation targets, for the initiation of resuscitation of very and extremely preterm infants ( & #x3c;32 weeks’ gestation). However, despite more than 10 randomized controlled trials on this question, the ideal initial oxygen concentration for this group of vulnerable infants remains uncertain. 〈 b 〉 〈 i 〉 Aims: 〈 /i 〉 〈 /b 〉 This study aims to assess the effect of various initial oxygen concentrations on (1) all-cause mortality, chronic lung disease, intraventricular hemorrhage, and retinopathy of prematurity; and (2) reaching the prescribed oxygen saturation targets by 5 min after birth, in preterm infants requiring resuscitation. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We will conduct a systematic review and network meta-analysis using individual participant data. Studies of preterm infants & #x3c;32 weeks’ gestation, randomized to initial oxygen concentration, will be included. We will systematically search medical databases and trial registries for eligible studies (published or unpublished). Records will be screened by two independent reviewers, with conflicts resolved by the inclusion of a third reviewer. Identified initial oxygen concentrations will be grouped into the following nodes: low (≤30%), intermediate (60%), and high (≥90%) oxygen. A two-step random-effects contrast-based network meta-regression will be calculated to compare and rank different oxygen concentrations. Analyses will be intention-to-treat, with the primary outcome of all-cause mortality. 〈 b 〉 〈 i 〉 Discussion: 〈 /i 〉 〈 /b 〉 This is the first individual participant data network meta-analysis of initial oxygen concentrations for the resuscitation of preterm infants. This novel approach may address long-standing uncertainty regarding optimal oxygen supplementation practice for the resuscitation of preterm infants & #x3c;32 weeks’ gestation.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000525127
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 2403535-X
    SSG: 12
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