Apneic Episodes Research Articles

Moderate ethanol exposure during early ontogeny of the rat alters respiratory plasticity, ultrasonic distress vocalizations, increases brain catalase activity, and acetaldehyde-mediated ethanol intake.

Early ontogeny of the rat (late gestation and postnatal first week) is a sensitive period to ethanol's positive reinforcing effects and its detrimental effects on respiratory plasticity. Recent studies show that acetaldehyde, the first ethanol metabolite, plays a key role in the modulation of ethanol motivational effects. Ethanol brain metabolization into acetaldehyde via the catalase system appears critical in modulating ethanol positive reinforcing consequences. Catalase system activity peak levels occur early in the ontogeny. Yet, the role of ethanol-derived acetaldehyde during the late gestational period on respiration response, ultrasonic vocalizations (USVs), and ethanol intake during the first week of the rat remains poorly explored. In the present study, pregnant rats were given a subcutaneous injection of an acetaldehyde-sequestering agent (D-penicillamine, 50 mg/kg) or saline (0.9% NaCl), 30 min prior to an intragastric administration of ethanol (2.0 g/kg) or water (vehicle) on gestational days 17-20. Respiration rates (breaths/min) and apneic episodes in a whole-body plethysmograph were registered on postnatal days (PDs) 2 and 4, while simultaneously pups received milk or ethanol infusions for 40-min in an artificial lactation test. Each intake test was followed by a 5-min long USVs emission record. On PD 8, immediately after pups completed a 15-min ethanol intake test, brain samples were collected and kept frozen for catalase activity determination. Results indicated that a moderate experience with ethanol during the late gestational period disrupted breathing plasticity, increased ethanol intake, as well brain catalase activity. Animals postnatally exposed to ethanol increased their ethanol intake and exerted differential affective reactions on USVs and apneic episodes depending on whether the experience with ethanol occur prenatal or postnatally. Under the present experimental conditions, we failed to observe, a clear role of acetaldehyde mediating ethanol's effects on respiratory plasticity or affective states, nevertheless gestational acetaldehyde was of crucial importance in determining subsequent ethanol intake affinity. As a whole, results emphasize the importance of considering the participation of acetaldehyde in fetal programming processes derived from a brief moderate ethanol experience early in development, which in turn, argues against "safe or harmless" ethanol levels of exposure.

Metapneumovirus Infections are Uncommon in Infants Younger than 60 Days of Age Admitted for Sepsis Evaluation.

The epidemiology and clinical manifestations of human metapneumovirus are not well studied in infants younger than 60 days of age. In this retrospective review of infants admitted for sepsis evaluation, we identified HMPV less frequently than other viral etiologies via nasopharyngeal multiplex polymerase chain reaction testing; in only 16 (1.9%) infants. Two infants had apneic episodes, but none had wheezing.

S239 The Association of Obstructive Sleep Apnea and Clostridium difficile: A Nationwide Inpatient Sample Analysis

Introduction: Obstructive sleep apnea (OSA) is a sleep disorder involving repeated apneic episodes during sleep due to an obstruction of the airflow. OSA predisposes individuals to community-acquired pneumonia due to upper airway microaspiration. Furthermore, hypoxia due to intermittent pharyngeal collapses is shown to cause a pro-inflammatory state and reduced NK cell cytotoxicity and maturation, which can increase the risks of infections due to suppression of immune response. Increased incidence of infections in the OSA subgroup leads to increased use of antibiotics. Antibiotic exposure is the primary risk factor for developing Clostridium difficile (C. diff) infection. In synchrony with this notion, the primary purpose of this study was to determine the association between OSA and C. diff infection. Methods: A retrospective analysis was conducted using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). Patients without C. diff were analyzed (control) and were randomly selected and matched to each patient who did have C. diff. Weighted logistic regression models were used to calculate the association between OSA and C. diff for different comorbidities. Results: A total of 7,135,090 patients were included in our analysis. The prevalence of C. diff was significantly higher in patients with OSA (1.19% vs. 1.00%, p< 0.0001). In addition, multiple comorbidities were significantly elevated in the OSA group compared to those without OSA, including alcohol and obesity (p< 0.0001). Conclusion: This study uses ICD-10-CM codes with a specific search code for OSA. Our large population database shows a significant association between OSA and C. diff. One of the hypotheses describing this increased association could be more antibiotic exposure in OSA subgroup leading to C. diff. Additional studies are needed to confirm or refute this association.

Rare Cause of Arrhythmia and Seizures in a Late-Preterm Newborn

Rare Cause of Arrhythmia and Seizures in a Late-Preterm Newborn

SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT

SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT

Lifestyle Behaviour and Obstructive Sleep Apnea (OSA): An Association Study Among Young Adults

Introduction: Lifestyle changes like low physical activity, smoking and consumption of alcohol have been reported to have an impact on Obstructive Sleep Apnea. Smoking was found to be associated with nocturnal hypoxemia and disturbed sleep. Apneic episodes are increased after alcohol consumption. Objectives: To determine the risk of developing Obstructive Sleep Apnea among young adults. Material and Methods: Participants were asked to fill in an online generated questionnaire on lifestyle habits in addition to the modified Berlin questionnaire and Epworth questionnaire. A total of 209 study participants were included in the study. A Chi-square test was applied. Results: Among 209 participants, 47(22.5%) were females and 162 (77.5%) were males. Snoring was reported in 90 (43.1%) of study participants. Around thirty-three, percent of participants were at higher risk of developing Obstructive Sleep Apnea and Obstructive Sleep Apnea was predicted in 21.5%. No association was found between the lifestyle behavioural factors and Obstructive Sleep Apnea. Conclusion: Though a significant association was not found between selected lifestyle factors and Obstructive Sleep Apnea risk, the role of lifestyle factors could not be undermined. A healthy lifestyle helps in preventing the occurrence of Obstructive Sleep Apnea.

Effects of Opioid Sparing Analgesia for Surgical Procedure of Laparoscopic Pyloromyotomy in Order to Enhance Recovery and Better Surgical Outcomes

Aim: To determine the analgesic efficacy in early post operative period with out respiratory depression and to determine surgical outcome for patients under laparoscopic pyloromyotomy.&#x0D; Methodology: This study was done at Pediatric surgery operating theatre and Post anesthesia care unit (PACU). Peoples University of Medical and Health Sciences for women (PUMHSW) Nawabshah during the period of 2010-2022. Total 103 cases were observed with n=68 male and n=35 females. Ethical approval was obtained from PUMHSW ethical review board and written informed consent was taken from subjects’ parents or guardians. Infants of both sexes with 2-4.5 kg weight, age 3-8 weeks and diagnosed cases of infantile hypertrophic pyloric stenosis (IHPS) patients confirm by ultrasound were included in this study. Patients with the age of more than 2 months, with significant co morbid conditions, required an additional procedure during the operation, and those subjects possess a contraindication to the laparoscopic approach in the opinion of either the surgeon or the anesthesiologist were excluded from this study. Postoperative pain was measured by using the Neonatal Infant Pain Scale (NIPS) at 30,60,90,120 mins after completion of surgery.&#x0D; Results: In current study 103 patients were participated with male (n=68) to female (35) ratio 1.94:1 with mean age 34.94±7.31 days. Mean weight of the patients were studied 3.08±0.59 kg. Laparoscopic surgical procedure are less painful and patients can be managed by non opioid analgesic combination of intravenous acetaminophen with local anesthetic infiltration to achieved adequate pain relief and avoidance of delayed recovery, postoperative respiratory depression.&#x0D; Conclusion: Laparoscopic pyloromyotomy is safe and effective technique without postoperative respiratory depression and apneic episodes and better surgical outcome especially when opioid sparing multimodal analgesia is given.

0708 Stage-dependent Differences in Central Sleep Apnea (CSA) Predominate in remedē System Pivotal Trial Participants

Abstract Introduction Differences in neuroventilatory control can impact the type and severity of sleep disordered breathing between non-REM and REM sleep. We examined the distribution of central apneic episodes in polysomnograms from subjects with predominantly central sleep apnea, who received phrenic nerve stimulation. Methods Baseline in-lab polysomnograms from patients enrolled in the remedē System Pivotal Trial were scored by a central core laboratory (n=151). Participants with predominantly CSA were enrolled if the apnea-hypopnea index (AHI)≥20/hr, the central apnea index (CAI) exceeded the obstructive apnea index (OAI), and the OAI did not exceed 20% of the total AHI. This post-hoc analysis compared sleep apnea indices in REM and non-REM sleep in those with ≥5 minutes REM sleep (n=131). Within-patient median non-REM - REM differences were calculated and compared. Results REM sleep time was 40 [Q1=28, Q3=64] minutes, and non-REM sleep time was 301 [Q1=269,Q3=344] minutes. AHI in REM sleep was 22/hr [Q1=9,Q3=44] and was 46/hr (Q1=33,Q3=60) in non-REM sleep, yielding a within-patient difference between non-REM and REM sleep of 22/hr ([Q1=6, Q3=34], p&amp;lt;.001). CAI in REM was only 4/hr (Q1=0, Q3=11), but in non-REM was 25/hr [Q1=16,Q3=43] with all patients having a CAI≥5/hr during non-REM. In REM, 70% had a CAI&amp;gt;0/hr and 46% had a CAI ≥5/hr. The CAI difference between non-REM and REM sleep was 18/hr [Q1=10, Q3=30; p&amp;lt;.001]. The OAI and mixed apnea index (MAI) differed by &amp;lt;1/hr (p=0.235 and &amp;lt;.001, respectively). Of note, the hypopnea index [HI] did not differ between REM and non-REM sleep (12/hr [Q1=2,Q3=22] vs. 11/hr [Q1=4, Q3=20], respectively, p=0.273), yet hypopneas constituted a greater proportion of total AHI during REM compared to non-REM sleep. Conclusion Among subjects with predominantly CSA, the prevalence and severity of CSA was greater in non-REM than REM sleep, yet low-level CSA persisted in REM sleep. Stage-related differences in CAI but not OAI, MAI or HI can be attributed to alterations in ventilatory rather than upper airway control in this CSA cohort. These differences in the type and severity of sleep disordered breathing episodes comprise a key diagnostic signature, for which specific CSA therapeutic strategies are indicated. Support (If Any) ZOLL Respicardia, Inc. and NIH R01 HL144859

0864 Severe Central Sleep Apnea

Abstract Introduction Central sleep apnea (CSA) is a rare form of sleep disordered breathing with repeated apneic episodes with absence of associated respiratory effort. CSA due to medication is well described in literature with opiate therapy. Baclofen which is a gamma-aminobutyric acid-B agonist with muscle relaxant properties has been implicated in CSA. We present a rare case of CSA likely due to chronic baclofen use. Patient underwent a polysomnogram (PSG) while on baclofen therapy which revealed severe central sleep apnea. Patient was weaned off baclofen therapy completely and a subsequent PSG was performed which revealed resolution of the CSA. Methods 28 year old male with cerebral palsy and neurogenic bladder who presented for evaluation of snoring, chronic insomnia and non-refreshing sleep. Overnight PSG was performed for further evaluation of his sleep related complaints while on chronic baclofen therapy, which revealed severe central sleep apnea. Trial of positive airway pressure therapy for treatment of CSA and supplemental oxygen therapy were attempted during the PSG but had to be terminated due to intolerance. Echocardiography and magnetic resonance imaging of the brain were performed to rule out congestive heart failure and Chiari malformation respectively, which revealed no underlying pathology to explaining the CSA. CSA in this patient was thought to be associated with chronic baclofen therapy. Patient was weaned off baclofen with repeat PSG revealing resolution of the CSA. Results 1st diagnostic PSG - on Baclofen: 139 central apneas, 6 obstructive apneas, 3 mixed apnea, and 38 hypopneas. This study showed severe central sleep apnea. The apnea-hypopnea index (AHI) was 51.5, REM index 21.8 and supine index 51.5. Central apnea index 39.5. Respiratory events were associated with moderate oxygen desaturations. The mean oxygen saturation during the study was 92.8%, with a minimum oxygen saturation of 81%. The patient spent 2.9 minutes with an oxygen saturation equal to or less than 88% for the entire study. CPAP titration was attempted and aborted, due to patient having difficulty tolerating CPAP. Supplemental oxygen was briefly added at 0.5 LPM, which was also discontinued due to patient complaining of burning sensation in the nose. Head of the bed was elevated at several levels (20 degrees, 30 degrees and 45 degrees) which did not attenuate the respiratory events. 2nd Diagnostic PSG – patient weaned off baclofen for study – Sleep efficiency reduced at 59.4%. Sleep onset latency 7.5 minutes. REM latency 163 minutes. 100% of total sleep time in supine position Moderate snoring. The apnea-hypopnea index (AHI) was 4.2, REM index 36.5 and supine index 4.2. Respiratory events were mainly noted using REM sleep. Respiratory events were associated with moderate oxygen desaturations. The mean oxygen saturation during the study was 93.9%, with a minimum oxygen saturation of 83%. The patient spent 1.2 minutes with an oxygen saturation equal to or less than 88% for the entire study. Labs and imaging – Workup for severe central sleep apnea after first diagnostic sleep study – Echo and MRI brain, which revealed no underlying pathology explaining his central sleep apnea. Therefore, thought to be due to baclofen. Conclusion 28 year old male, concurrent and past medical history of cerebral palsy, neurogenic bladder. Presented, initially to sleep medicine clinic for complaints of insomnia, snoring, and non-refreshing sleep. Wheelchair bound. Has muscle spasticity, was on baclofen. Underwent initial sleep study, for snoring and insomnia. The initial PSG was on baclofen doses. His initial PSG – showed apnea-hypopnea index (AHI) of 51.5, REM index 21.8 and supine index 51.5, Central apnea index 39.5. Oxygen nadir – 81%. Patient had 139 central sleep apnea events. Patient had MRI and echo, which revealed no pathology to explain his severe central sleep apnea. Baclofen on his medicine list – was the concern for the driving force behind his central sleep apnea. As a result, baclofen was weaned and stopped. Repeat PSG – showed moderate snoring, overall AHI greatly improved from first study to 4.2. Respiratory events were associated with moderate oxygen desaturations. The mean oxygen saturation during the study was 93.9%, with a minimum oxygen saturation of 83%. The patient spent 1.2 minutes with an oxygen saturation equal to or less than 88% for the entire study. In closing – due to the side effect profile of baclofen leading to central sleep apnea in this case, recommend alternative therapy in place of baclofen due to severe central sleep apnea with baclofen use. Support (If Any) 1. Ghanavatian S, Derian A. Baclofen. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 15, 2021.2. Locatelli F, Formica F, Galbiati S, et al. Polysomnographic Analysis of a Pediatric Case of Baclofen-Induced Central Sleep Apnea. J Clin Sleep Med. 2019;15(2):351-354. Published 2019 Feb 15. doi:10.5664/jcsm.76443. Olivier PY, Joyeux-Faure M, Gentina T, et al. Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy: A Case Series. Chest. 2016;149(5):e127-e131. doi:10.1016/j.chest.2015.10.001

NIV-NAVA versus NCPAP immediately after birth in premature infants: A randomized controlled trial

ObjectiveTo evaluate whether noninvasive-neurally adjusted ventilatory assist (NIV-NAVA) decrease respiratory efforts compared to nasal continuous positive airway pressure (NCPAP) during the first hours of life. MethodsTwenty infants born between 28+0 and 31+6 weeks were randomized to NIV-NAVA or NCPAP. Positive end-expiratory pressure was constantly kept at 6 cmH2O for both groups and the NAVA level was 1.0 cmH2O/µV for NIV-NAVA group. The electrical activity of diaphragm (Edi) were recorded for the first two hours. ResultsPeak and minimum Edi decreased similarly in both groups (P = 0.98 and P = 0.59, respectively). Leakages were higher in the NIV-NAVA group than in the NCPAP group (P < 0.001). The neural apnea defined as a flat Edi for ≥ 5 s were less frequent in NIV-NAVA group than in NCPAP group (P = 0.046). ConclusionsImmediately applied NIV-NAVA in premature infants did not reduce breathing effort, measured as peak Edi. However, NIV-NAVA decreased neural apneic episodes compared to NCPAP.

Comparison of low-dose morphine intrathecal analgesia and sufentanil PCIA in elderly patients with hip fracture undergoing single spinal anesthesia \u2014 a randomized clinical trial

BackgroundThe complications of postoperative pain, such as hypertension, hypermetabolism, irritability, and postoperative cognitive dysfunction, significantly affect the postoperative rehabilitation of elderly patients. Intrathecal morphine prolongs analgesia after surgery, but has been implicated in nausea and vomiting, pruritus, postoperative respiratory depression, or apneic episodes. The present study explored the effect and safety of low-dose morphine used adjunctively with bupivacaine during single spinal anesthesia or sufentanil patient-controlled intravenous analgesia (PCIA) in elderly patients with hip fracture surgery. Since elderly patients often need anticoagulant therapy in the early postoperative period, single spinal anesthesia was involved in completing the operation in this study.MethodsEighty elderly patients aged 70–85 years who underwent elective hip fracture surgery with single spinal anesthesia were divided into two groups, 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of morphine (morphine group, group M) and 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of sufentanil PCIA (sufentanil group, group S). The analgesia scores using the visual analogue scale (VAS), the Brinell comfort scale (BCS) were evaluated at 6, 12, 24, and 48 h after operation, and adverse reactions were recorded such as nausea and vomiting, pruritus, sedation, respiratory depression, and POD (postoperative delirium) with Delirium Rating Scale-r 98.ResultsWithin 24 h after operation, the analgesic and BCS scores of group M were better than those of group S (P < 0.05). Group M had higher frequency of skin pruritus than group S within 24 h, and the difference was statistically significant. The incidence of POD in group M (2 cases) was lower than that in group S (6 cases) (5.71% vs 18.18%) (P < 0.05) with the DRS-r 98 scores. No significant difference was observed in nausea and vomiting between the two groups, and the difference of severe respiratory depression was not found in both groups.ConclusionCompared with sufentanil PCIA, low-dose intrathecal morphine has a satisfactory analgesic effect, and little effect on the patient's cognitive function with low medical cost. Under effective respiratory monitoring, it can be used safely and effectively in elderly patients with hip fracture.Trial registrationRegistered with the Chinese Clinical Trial Registry under ChiCTR2100042706. 26/01/2021.

Development of Physiologically Based Pharmacokinetic Model and Assessment of the Impact of Renal Underdevelopment in Preterm Infants on the Pharmacokinetics of Aminophylline

Objective: To develop a physiologically based pharmacokinetic (PBPK) model for individualization of the dosing regimen considering the physiological requirements of these preterm neonates. Methods: The study comprised preterm newborns with fewer than 34 weeks of gestation and six apneic episodes in 24 h. A PBPK model was created using PK-SIM (version 9, update 1, GitHub, San Francisco, CA, USA). A PBPK model is built using a typical loading dosage of 5 mg/kg and a maintenance dose of 1.5 mg/kg. Based on the verified base model, a PBPK model representing renal underdevelopment based on nRIFLE/pRIFLE categorization was developed. Results: The PK parameters of Aminophylline were computed using the PBPK model. As per the model prediction, T1/2 and area under the curve reduced as postnatal age increased, and in the event of renal underdevelopment, even while C max for patients under R (RISK), I (injury) was within the therapeutic range; it was greater compared to preterm without any renal complications. Mean C max (mol/L) was 59.53 and for R, I, and F (FAILURE) categories the values were 83.04, 99.69, and 126.98, respectively. Conclusion: The model was created using appropriate drug, study subject, and dosage protocol inputs. The established PBPK model could help in individualizing aminophylline dose in preterm babies.

Hairy Polyp of the Oropharynx: An Unusual Cause of Choking, Feeding Problems in a Newborn

Hairy polyp is an unusual, rare benign developmental malformation of neonates and infants. Embryologically, they are benign lesions containing of both ectodermal and mesodermal origin. Based on size, location of the lesion, they can produce symptoms such as feeding difficulties, airway obstructions, apneic episodes. We present a case of hairy polyp at Oro/Nasopharynx causing feeding difficulties immediately after birth. We explained the mode of presentation, imaging studies, treatment, and review of literature of congenital hairy polyp/choristoma.

Effectiveness of Reverse Kangaroo Mother Care Position in Decreasing Adverse Physiological Events and Pain during Screening of Premature Infants for Retinopathy of Prematurity

Background. Retinopathy of prematurity (ROP) screening is uncomfortable and even painful in preterm infants.&#x0D; Objective. To determine the effectiveness of the Reverse-Kangaroo Mother Care (R-KMC) position compared with the conventional position in decreasing adverse physiological events and pain during ROP screening.&#x0D; Methods. This was a parallel randomized controlled trial with two arms- R-KMC position and conventional position (control). The primary outcomes included increased oxygen saturation, decreased heart and respiratory rates, and decreased pain intensity measured by Prematurity Infant Pain Profile (PIPP).&#x0D; Results. There were 100 preterm infants recruited. There were no differences in baseline characteristics, mean ROP screening duration, mean physiological parameters after the mydriatic application and during ROP screening between the two. Only the mean respiratory rates were significantly lower among the R-KMC group during the application of mydriatric agent. (50.26 ± 6.18 vs. 51.6 ± 8.35; p=0.0191). Relative risk (RR) in the control group is 37 to 84 versus 40 to 68 in the R-KMC group. The R-KMC group had a significantly lower mean PIPP score (6.5±2.06 vs. 8.8±2.80; p&lt;0.0001) after mydriatic application and during ROP screening (7.6±2.05 vs. 9.8±2.90; p&lt;0.0001) compared with control. No apnea was observed after mydriatic application, but one apneic episode was in control during ROP screening. 26% of the ROP screeners recommended the R-KMC position during ROP screening, while a majority (70%) was neutral.&#x0D; Conclusion. R-KMC position, a low-cost intervention, significantly reduces pain during ROP screening. It is recommended as a position of choice during ROP screening.

Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome.

To examine the changes of upper airway cross sectional area in each phase of respiration in different degrees of severity of OSAS with computed tomography and cephalometry to decide on further treatment. A Prospective study was done in the Department of Radiology and Imaging, Kasturba Medical College, Mangalore, spanning over a period from March 2017 to December 2019. 50 patients were included in the study including control group. Patients who had at least 2-3 major symptoms of sleep apnea such as snoring, daytime somnolence, and apnea were included in this study. All patients were examined and then subjected to polysomnography(PSG) and upper airway CT. Patients with apnea-hypopnea index (AHI) of < 5 on Polysomnography were included in the control group and those with AHI of > 5 were categorized in to the study group Cross-sectional area of the airway at the level of the nasopharynx, oropharynx and the hypopharynx were obtained. Standard cephalometric measurements were made on a lateral radiograph of skull/ CT scanogram. Of the 36 patients in the study group, 31 patients were males and 5 were females. In the control group of 12 patients, 8 were males and 4 females. The cross sectional area at the lower border of the nasopharynx which is also the level of the nasopharyngeal sphincter was the most affected level in OSAS (p value of < 0.0001). Mean uvular diameter in the control group was 9.6mm and in the OSAS group it was 11.2mm. The mean length of the soft palate was 36.4mm in the controls, 39.5mm in the mild/moderate OSAS and 41.2mm in the severe OSAS group. Obstructive sleep apnea is a complex disorder characterized by apneic episodes during sleep. In this study the most common site of obstruction is nasopharyngeal sphincter and the oropharynx. Although PSG is the diagnostic test of choice, imaging plays an important role in planning surgical and conventional treatment.

Predictors of mortality in premature babies with respiratory distress syndrome treated by early rescue surfactant therapy.

To determine the predictors of mortality following early rescue surfactant therapy in preterm babies with respiratory distress syndrome. Prospective cohort study enrolling babies between 28 weeks to 34 weeks with respiratory distress syndrome requiring early rescue surfactant therapy. For statistical analysis babies were further divided into two subgroups: survivors and non-survivors. Maternal and neonatal variables were compared between the two groups to find out the predictors of mortality. Out of total 110 babies, 72 (65.45%) survived. The mean birth weight and mean gestational age of the study population was 1614.36 (±487.86) g and 31.40 (±2.0)1 weeks, respectively. Birth weight < 1500 g, gestational age < 32 weeks, primiparity, vaginal delivery, prolonged rupture of membranes, lack of antenatal steroid cover, bag and mask ventilation at birth, sepsis, apneic episodes and mechanical ventilation were significantly associated with death on univariate analysis. On multivariate analysis, very low birth weight, vaginal delivery, lack of antenatal steroid cover, bag and mask ventilation at birth and mechanical ventilation were found to be independent predictors of mortality. Some of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to predict the clinical severity and mortality among these babies.

Chorioamnionitis, Inflammation and Neonatal Apnea: Effects on Preterm Neonatal Brainstem and on Peripheral Airways: Chorioamnionitis and Neonatal Respiratory Functions.

Background: The present manuscript aims to be a narrative review evaluating the association between inflammation in chorioamnionitis and damage on respiratory centers, peripheral airways, and lungs, explaining the pathways responsible for apnea in preterm babies born by delivery after chorioamnionitis. Methods: A combination of keywords and MESH words was used, including: “inflammation”, “chorioamnionitis”, “brainstem”, “cytokines storm”, “preterm birth”, “neonatal apnea”, and “apnea physiopathology”. All identified papers were screened for title and abstracts by the two authors to verify whether they met the proper criteria to write the topic. Results: Chorioamnionitis is usually associated with Fetal Inflammatory Response Syndrome (FIRS), resulting in injury of brain and lungs. Literature data have shown that infections causing chorioamnionitis are mostly associated with inflammation and consequent hypoxia-mediated brain injury. Moreover, inflammation and infection induce apneic episodes in neonates, as well as in animal samples. Chorioamnionitis-induced inflammation favors the systemic secretion of pro-inflammatory cytokines that are involved in abnormal development of the respiratory centers in the brainstem and in alterations of peripheral airways and lungs. Conclusions: Preterm birth shows a suboptimal development of the brainstem and abnormalities and altered development of peripheral airways and lungs. These alterations are responsible for reduced respiratory control and apnea. To date, mostly animal studies have been published. Therefore, more clinical studies on the role of chorioamninitis-induced inflammation on prematurity and neonatal apnea are necessary.

Comparative evaluation of efficacy of oxygenation using high flow nasal cannula vs. conventional nasal cannula during procedural sedation for endoscopic ultrasound: A pilot study.

Background and Aims:High flow nasal cannula (HFNC) has numerous advantages against conventional oxygen therapy delivery systems. However, there is limited evidence supporting the use of HFNC in endoscopic ultrasound (EUS) under procedural sedation. The aims of this study is to evaluate the efficacy of two different oxygen delivery devices, that is,HFNCand conventional nasal cannula on the oxygenation status of patients during procedural sedation for EUS.Material and Methods:Sixty adult patients undergoing EUS for various ailments were randomized to two groups group HFNC (n=30) and group nasal cannula [NC (n = 30)]. HFNC (AIRVO2, Fisher and Paykel Healthcare, New Zealand) was used on patients in the group HFNC. Respiratory status of the patients was assessed using pulse oximetry, respiratory rate, procedural airway complications, and oxygen therapy adjustments. The endoscopist assessed the ease of performing EUS at the end of the procedure and patient satisfaction score (PSS) was assessed by using a Likert score in the post-anesthesia care unit.Results:SpO2 measurements in the HFNC group during the procedure were marginally better compared to the NC group but this failed to reach statistical significance. Also, no significant association was found between both groups while comparing desaturation events (P = 0.499), patient satisfaction score (PSS) and endendoscopist’s satisfaction score (ESS) (P = 0.795). Both the groups were comparable in terms of airway manipulation, use of airway adjuncts, need to increase oxygen flow rate, endoscope removal, apneic episodes, hypotension, and bradycardia. No major complications were observed in either group.Conclusion:HFNC use in patients undergoing EUS is not superior when compared to conventional nasal cannula oxygen therapy. HFNC failed to show any significant impact on decreasing the risk of desaturation events and airway manipulation during the procedure.

Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy.

Surfactant delivery via a thin endotracheal catheter during spontaneous breathing; a technique called minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant administration. Procedural details among different centers vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess suction catheters, vascular catheters, and more recently custom-built catheters for this purpose. The impact of choice of catheter on procedural success and procedural adverse effects has not been reported. Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multiaccess catheter (MAC). This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in Southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics and data on procedural details (premedication, type of catheter, etc.) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath was compared by using Chi-square test or Fisher's test as appropriate. A p-value of less that 0.05 was considered significant. A total of 139 neonates received surfactant via MIST method during the study period. Moreover, 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two group were similar. A higher proportion of neonates in Angiocath group received Atropine (100 vs. 76%, p = 0.002) and Fentanyl (98 vs. 36%, p < 0.001) than the MAC group.The procedural success was 91% in the Angiocath group and 89% in the MAC group (p > 0.99). Multiple attempts were needed in 24% of neonates in the Angiocath group and 37% in the MAC group (p = 0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%; p = 0.012). Other rates of common adverse effects were similar between the two groups. On exploratory analysis fentanyl use held significant association with less success, more desaturation, apneic episodes, and need of positive pressure ventilation /intubation. The overall procedural success of MIST is similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with the Angiocath, though difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, which was related to higher use of procedural sedation in this group. · MIST is emerging as a less invasive method of surfactant delivery that has proven clinical benefits.. · Considerable, procedural variation is reported, particularly regarding choice of catheter.. · Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart method) versus a flexible MAC.. · High and comparable procedural success was seen in both groups..

Severe Snoring in a Young Healthy Female: A Diagnostic Surprise.

Laryngeal Inflammatory myofibroblastic tumors or plasma cell granulomas are unusual benign lesions. Subglottic laryngeal lesions of various benign and malignant types usually present with acute or chronic stridor and respiratory obstruction features. We describe the first case in the literature where severe snoring was the presenting complaint in a patient of subglottic mass lesion with comfortable breathing during wake hour. A 28years old female presented with loud snoring and apneic episodes during sleep for three years which showed severe Obstructive Sleep Apnoea (OSA) (AHI, Apnoea- Hypoapnoea Index: 46.5) in polysomnography (PSG) and surprisingly smooth mucosa covered subglottic mass blocking 75% of airway lumen in the laryngoscopic examination. The patient underwent tracheostomy and coblation assisted endoscopic excision, and subsequent histopathology revealed an inflammatory myofibroblastic tumour. She was later decannulated and with no features of sleep apnea post decannulation. Subglottic mass can rarely present with severe snoring and requires solid clinical suspicion for early diagnosis. Hence, subglottic lesion should be one of the differentials for atypical presentations of severe OSA.