Continuous Positive Airway Pressure Support Research Articles

Clinical characteristics of 14 cases of neonatal tracheotomy in neonatal intensive care unit

Objective: To analyze the clinical characteristics of neonatal tracheotomy in neonatal intensive care unit (NICU). Methods: This single-center retrospective study included 14 neonates admitted to NICU of Beijing Children's Hospital, Capital Medical University from January 2016 to August 2021, and were<28 days of age on admission, who met the criteria of tracheotomy and finally completed the procedure. The clinical characteristics including age, weight, duration of ventilation, etiology of tracheotomy, length of hospital stay and prognosis were summarized and analyzed. Wilcoxon signed-rank test was used to compare the weight gain velocity and the duration of ventilation before and after tracheotomy. Paired t-test was used to compare the hospitalization length before and after tracheotomy. Spearman correlation was used to analyze the correlation between the clinical characteristics and outcomes. Results: For the 14 neonates, the gestational age was (38±4) weeks and birth weight was (2 824±949) g. Nine of them were male. The age on transportation was 16 (6, 25) d. A total of 10 neonates were on invasive ventilation on admission, the other 4 were on nasal continuous positive airway pressure support. Bilateral vocal cord paralysis (7 cases) was the commonest cause of tracheotomy. The age on operation was 33 (22, 44) d. There were statistically significant differences in duration of ventilation and weight gain velocity before and after operation (19.00 (10.50, 34.00) vs. 0.86 (0.06, 3.25) d, 1.66 (-0.16, 5.54) vs. 4.69 (2.30, 9.32) g/(kg·d), Z=3.01 and -1.98, both P<0.05). The total hospital stay in NICU was (37±12) d. One neonate died during hospitalization. The existence of pneumonia on admission was positively correlated to NICU stay length (r=0.57, P=0.027), the pre-operational weight gain velocity was negatively correlated to the post-operational NICU stay length (r=-0.73, P=0.020). There were 4 neonates de-cannulated during 7-38 months after the tracheotomy, and 5 neonates still wearing the tracheal cannulation during 15-66 months after the tracheotomy. Two neonates died and 2 neonates lost follow-up after discharge. All neonates could not vocalize normally before de-cannulation, and the language development obviously lagged behind the normal age group after de-cannulation. Conclusions: Bilateral vocal cord paralysis is the commonest cause of neonatal tracheotomy. The benefit of tracheotomy for NICU neonates with surgical indications is obvious, especially in facilitating extubation and improving weight gain.

Community-acquired pneumonia and non-invasive ventilation-a valid ICU avoidance strategy?

The British Thoracic Society guidelines state that neither non-invasive ventilation (NIV) nor continuous positive airway pressure support is routinely indicated in the management of patients with respiratory failure due to community-acquired pneumonia (CAP).1 These guidelines were published some years ago—is there now more robust recent evidence to support the use of NIV in pneumonia? We therefore welcome the meta-analysis by Dr Klefti and colleagues at the University of Edinburgh which addresses this important question. In more recent times, the QJM has been publishing relevant meta-analysis on clinically relevant issues related to acute coronavirus disease 2019 (COVID-19) infection.2–5 As we learn to live with COVID, we welcome reviews relating to pertinent non-COVID clinical questions. In relation to the pertinent clinical question—is NIV indicated in the management of CAP—the authors report a significant benefit, in particular with regards to NIV significantly reducing the rate of endotracheal intubation (risk ratio (RR) 0.46, 95% confidence interval (CI) [0.26–0.79]), and ICU mortality rate (RR 0.3, 95% CI [0.09–0.93]). National clinical guidelines are the foundation stone for best clinical practice. The British Thoracic Society last published full clinical guidelines for the management of CAP 13 years ago—perhaps it is time for an update?

0811 Patient with Pierre Robin Sequence and Moebius Syndrome - Diagnostic and Treatment Challenges

Abstract Introduction Pierre Robin sequence includes craniofacial anomalies - micrognathia, mandibular hypoplasia, glossoptosis, and cleft palate resulting in obstructive sleep apnea (OSA), respiratory dysfunction, and feeding difficulties. Moebius syndrome is a brainstem anomaly that causes cranial nerve VI and VII palsy, causing oculofacial paralysis, palatal weakness with feeding difficulties, and aspiration. We present a case of an infant with Pierre Robin and Moebius syndrome with sequalae of both - OSA and aspiration diagnosed after the neonatal period. Report of Cases: A 4-month-old male infant was referred for suspected sleep-disordered breathing (SDB) in context of Pierre Robin sequence, Moebius syndrome, and a premature birth at 32 weeks gestation. Shortly after birth, the patient experienced respiratory distress requiring continuous positive airway pressure (CPAP) support in the neonatal intensive care unit. Also, he required a pediatric intensive care admission at 2 months of age for acute respiratory failure with hypoxemia requiring high-flow nasal cannula, and difficulty feeding. Parents reported snoring, apneas with cyanosis, and gasping respirations at night. Physical exam demonstrated micrognathia, glossoptosis, high-arched narrow palate, and the inability to fully close his eyes or mouth. Care at an outside facility did not include a laryngoscopy, swallow study, or sleep study. The patient had inadequate weight gain, eventually developed failure to thrive (FTT), and was admitted for an upper respiratory tract infection and dehydration that required a nasogastric tube. An urgent split-night polysomnogram was performed, which demonstrated OSA with an apnea-hypopnea index (AHI) of 22/hour and an oxygen saturation nadir of 83%. Use of 0.5 L/min of supplemental oxygen via nasal cannula, lowered his AHI to 1/hour. Urgent referrals to otolaryngology, oral and maxillofacial surgery were placed and both specialties recommended delay in surgical intervention. A swallow study was performed and demonstrated aspiration with all consistencies. He was discharged with supplemental oxygen for OSA with gastrostomy tube placement pending. Conclusion This case highlights a delayed diagnosis of OSA and aspiration in an infant with Pierre Robin and Moebius syndrome with FTT. The presentation emphasizes the importance of early recognition of SDB to provide appropriate treatment during the essential developmental stages of life. Support (If Any)

Study of Orofacial Function in Preschool Children Born Prematurely.

Children born prematurely often exhibit orofacial dysfunction. We conducted Nordic Orofacial Test Screening and analyzed chewing and swallowing functions of 243 children aged 3–5 years, consisting of 142 and 101 children born full-term and preterm, respectively, to evaluate the orofacial function of preschool premature children. Categorical variables were analyzed using chi-square test for a comparison. The univariate analysis of variance was used to analyze the effects of birth weight, gestational age, intubation at birth, use of nasal continuous positive airway pressure support after birth, and use of nasogastric tube on the chewing and swallowing functions of children born prematurely. In this survey, term-born children had a higher incidence of bad oral habits, grinding teeth while sleeping, and abnormal gulping compared to preterm-born children. Preterm-born children had a higher incidence of choking, decreased mouth opening (<30 mm), abnormal dental arch form, abnormal palatal vault, and dysarthria compared to term-born children.

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey.

BackgroundThere is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum (PTM). We aimed to determine its incidence among patients hospitalised with COVID-19 in the UK and describe factors associated with outcome.MethodsA structured survey of PTM and its incidence was conducted from September 2020 to February 2021. UK-wide participation was solicited via respiratory research networks. Identified patients had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and radiologically proven PTM. The primary outcomes were to determine incidence of PTM in COVID-19 and to investigate risk factors associated with patient mortality.Results377 cases of PTM in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 PTM was 195 out of 377 (51.7%). PTM in COVID-19 was associated with high rates of mechanical ventilation. 172 out of 377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 PTM at the time of diagnosis and thereafter (p<0.001), along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airway pressure support to oxygen or high-flow nasal oxygen after the diagnosis of PTM was not associated with difference in mortality.ConclusionsPTM appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom PTM was identified had not been mechanically ventilated at the point of diagnosis.

Lung volume distribution in preterm infants on non-invasive high-frequency ventilation

IntroductionNon-invasive high-frequency oscillatory ventilation (nHFOV) is an extension of nasal continuous positive airway pressure (nCPAP) support in neonates. We aimed to compare global and regional distribution of lung volumes during...

Anesthetic challenges in an infant with multiple structural airway anomalies

Airway anomalies such as laryngomalacia, laryngeal webs, micrognathia, and retrognathia cause respiratory distress in infants and pose a significant challenge in anesthetic management. We report the case of a 2-month-old infant with laryngomalacia on continuous positive airway pressure support since birth, posted for laryngeal surgery, who was found to have micro-retrognathia during pre anaesthesia checkup. Securing the airway and preventing hypoxia were the main challenges in this child. Adequate measures were taken for continuous oxygenation during induction of anesthesia. The child underwent supraglottoplasty with an uneventful intraoperative course. However, the airway obstruction persisted in the postoperative period requiring a surgical tracheostomy. The child subsequently underwent mandibular distraction surgery after 1 month and was discharged with a tracheostomy tube. Although various anesthetic options have been described to manage the difficult pediatric airway, the anesthetic technique should be customized to ensure airway patency and oxygenation in the perioperative period as illustrated in this case report.

New parameters on prediction of severity of transient tachypnea of the newborn.

Transient tachypnea of the newborn (TTN) is a common clinical problem that often occurs in the first hours of life. Although it is considered to be a benign clinical course, some cases may have severe symptoms and require ventilation support. In this study, we aimed to determine the association between the mean platelet volume (MPV), nucleated red blood cells (NRBCs), right ventricular systolic pressure (RVSP), and the severity of TTN. Patients with TTN were divided into two groups according to Silverman score (<7: group 1 [n: 34] and ≥7: Group 2 [n: 30]). The groups were compared in terms of demographic characteristics, hematologic parameters, and RVSP within the first 24 hours after admission. Mean birth weight of the patients was 3033.4 ± 364.1 g and median gestational age was 38 weeks (min-max: 34-42). Patients in Group 2 were found to require higher nasal continuous positive airway pressure (nCPAP) support and longer duration of oxygen treatment (p: 0.001). Patients in Group 2 had significantly higher thrombocyte, absolute NRBCs count, NRBCs/100 WBCs, and RVSP levels (p < 0.05). Hemoglobin and hematocrit levels were found significantly higher in group 1(p < 0.05). In logistic regression analysis, NRBCs/100 WBCs was found to be the most important independent parameter that affects Silverman score at admission (OR: 7.065, CI: 1.258-39.670, p: 0.026). This is the first study that investigates the association between NRBCs, RVSP, and severity of TTN. We think that elevated NRBCs and RVSP values are helpful for clinicians in decision making for referral of the patients to a secondary or a tertiary level of NICU and also inform the families about prognosis.

Scalability of the Basic Care Model for Very Low Birth Weight Infants and Implementation Research Considerations

Objectives: To study the scalability of the rural hospital (RH) model of basic newborn care in a general hospital (GH) by including very low birth weight (VLBW) infants, and to assess the implementation aspects.&#x0D; Study design: Observational&#x0D; Settings: RH (1988-1992) and General Hospital, (GH) (2010-2013).&#x0D; Subjects: VLBW infants with birth weight ranging from 1000 g to 1500 g.&#x0D; Interventions: (1) RH: Basic care including warmth, feeding, antibiotics, and oxygen (2) GH: Basic plus circulatory care (2010-12), and continuous positive airway pressure (CPAP) support (2013). Mechanical ventilation and surfactant therapy were not available.&#x0D; Main outcome measure: Mortality&#x0D; Results: The cumulative mortality (38.5%) with basic neonatal care in the RH model declined to 26.6% at the GH with the addition of circulatory support and a “home-made” CPAP system.&#x0D; Conclusions: The RH package may be scaled up by adding CPAP and circulatory support to reduce the mortality among VLBW infants. The RH model is scalable horizontally and vertically.&#x0D; What is already known about this subject?&#x0D; &#x0D; Implementation research constitutes a relatively new and underdeveloped field,&#x0D; One of the facets of health system research is the implementation research.&#x0D; Implementation research aims at bridging the gaps between knowledge and action.&#x0D; &#x0D; What does this study add?&#x0D; &#x0D; Tertiary care center can help in developing basic newborn care at a rural hospital.&#x0D; The rural hospital model can be upscaled vertically as well as horizontally.&#x0D; Addition of circulatory support and CPAP to basic newborn care can significantly lower neonatal mortality.&#x0D; &#x0D; How might it impact on clinical practice in the foreseeable future?&#x0D; The study may encourage tertiary care centers to facilitate the development of basic newborn care centers at the rural hospitals. These centers, in turn, can spread horizontally.

A Late-Preterm Infant with Ichthyosis, Pancytopenia, and Recurrent Sepsis.

A Late-Preterm Infant with Ichthyosis, Pancytopenia, and Recurrent Sepsis.

Lung Deposition of Surfactant Delivered via a Dedicated Laryngeal Mask Airway in Piglets.

It is unknown if the lung deposition of surfactant administered via a catheter placed through a laryngeal mask airway (LMA) is equivalent to that obtained by bolus instillation through an endotracheal tube. We compare the lung deposition of surfactant delivered via two types of LMA with the standard technique of endotracheal instillation. 25 newborn piglets on continuous positive airway pressure support (CPAP) were randomized into three groups: 1—LMA-camera (integrated camera and catheter channel; catheter tip below vocal cords), 2—LMA-standard (no camera, no channel; catheter tip above the glottis), 3—InSurE (Intubation, Surfactant administration, Extubation; catheter tip below end of endotracheal tube). All animals received 100 mg·kg−1 of poractant alfa mixed with 99mTechnetium-nanocolloid. Surfactant deposition was measured by gamma scintigraphy as a percentage of the administered dose. The median (range) total lung surfactant deposition was 68% (10–85), 41% (5–88), and 88% (67–92) in LMA-camera, LMA-standard, and InSurE, respectively, which was higher (p < 0.05) in the latter. The deposition in the stomach and nasopharynx was higher with the LMA-standard. The surfactant deposition via an LMA was lower than that obtained with InSurE. Although not statistically significant, introducing the catheter below the vocal cords under visual control with an integrated camera improved surfactant LMA delivery by 65%.

Initial respiratory support modality and outcome in preterm infants with less than 32weeks of gestation in China: A multicentre retrospective cohort study.

BackgroundFor initial respiratory management, continuous positive airway pressure (CPAP) is increasingly used for preterm infants, especially for gestational age less than 32 weeks. However, neonatologists are concerned about the potential risks of CPAP support failure.ObjectivesTo examine the association between different initial respiratory support modalities and the outcomes of preterm infants at <32 weeks of gestation across multiple neonatal intensive care units (NICU) in China.MethodsThis study was carried out over a period of 12 months in 2018. Unadjusted relative risks (RR) for demographic and clinical characteristics were calculated for CPAP failure and CPAP success in the total cohort using log‐linear model based on generalised estimating equations for clustered observations.ResultsAmong 1560 preterm infants delivered at <32 weeks, the incidence of CPAP failure was 10.3%. After adjustment for demographic and clinical factors, the relative risk of mortality (RR 7.54, 95% CI 5.56, 10.44), pneumothorax (RR 9.85, 95% CI 2.89, 61.53), pulmonary haemorrhage (RR 7.78, 95% CI 4.51, 14.64) and BPD (RR 3.65, 95% CI 3.65, 4.51) were considerably higher for infants in the CPAP failure group than those in the CPAP‐S group. However, the risk of poor outcomes in CPAP failure infants was similar to that of those in the initial mechanical ventilation (MV) group.ConclusionsContinuous positive airway pressure failure was associated with an increased risk of mortality and major morbidities, including BPD, pulmonary haemorrhage and pneumothorax, and was comparable to the risk associated with initial MV.

Outcomes of Continuous Positive Airway Pressure in the Management of Patients with Coronavirus (COVID-19) Pneumonia who are not Suitable for Invasive Ventilation.

Background:The optimum management of respiratory failure in patients with coronavirus (COVID-19) infections has been a challenge for physicians across the globe. Many scientific societies have suggested the use of CPAP (continuous positive airway pressure) in severe cases in an effort to reduce invasive ventilation. We investigated mortality outcomes in patients who needed CPAP but were not suitable for invasive ventilation.Methods:We retrospectively evaluated the mortality outcomes of all consecutive COVID-19 cases with severe type 1 respiratory failure requiring FiO2 >0.6 who were admitted to our hospital between 12th March and 04th May’20. British Thoracic Society guidelines were followed for identifying patients needing CPAP. Their outcomes were recorded and compared with a similar group of patients who had oxygen as a ceiling of care. Prospectively collected data between 5th May and 7th June’20 in similar but smaller groups of patients was also analyzed.Results:A total of 104 COVID-19 patients with documented Do Not Attempt Resuscitation (DNAR) decision required high fraction of inspired oxygen (FiO2) >0.6(to maintain peripheral oxygen saturation (SpO2)> 92%(SpO2> 88% in COPD patients). Twenty-four patients received CPAP as the ceiling of care, with a mortality rate of 92.5%. The remaining 84 patients who were on oxygen as a ceiling of treatment had 91.7% mortality. Both population groups had a similar number of comorbidities but were less favorable in terms of age in the control group with standard O2 therapy than those who had CPAP support. Overall mortality outcomes from using CPAP therapy did not bring significant mortality benefit (p-value-0.89).Conclusion:CPAP did not appear to improve the survival of patients with severe respiratory failure due to COVID-19 related pneumonia and were not suitable for invasive ventilation. Further studies are warranted to adequately inform appropriate management strategies for this group of patients.

Minimally invasive surfactant therapy for moderate to late premature neonates with respiratory distress syndrome born in a non-tertiary unit.

Minimally invasive surfactant therapy (MIST) is used to deliver exogenous surfactant to preterm neonates with respiratory distress syndrome. The objective of this study was to review the use of MIST in moderate to late preterm neonates born in a non-tertiary unit. A retrospective review was conducted of neonates receiving MIST in a non-tertiary unit. MIST was considered in neonates requiring continuous positive airway pressure ≥ 6cm H2 O and fraction of inspired oxygen ≥ 0.35. The Hobart method was used to deliver exogenous surfactant. The primary outcome was improvement in respiratory function. Secondary outcomes include intubation and transfer to a tertiary unit. Between 2016 and 2020, 23 infants were treated with MIST. The median gestational age was 33+5 ± 2.7 weeks and mean age of surfactant administration was 6.6± 3.6h. Surfactant administration resulted in a reduction in median fraction of inspired oxygen from 0.3 to 0.21 at 4h post MIST (P value: 0.001), and a reduction in median positive end-expiratory pressure (PEEP) from 7 to 6 cm H2 O at 24 h post MIST (P value: 0.003). Continuous positive airway pressure support was required for a median period of 3.5 days following MIST. There was respiratory improvement in 52 and 65% of neonates at 4 and 24 h, respectively, following MIST. The incidence of intubation was 13% and transfer to a tertiary unit was 44%. Use of MIST at this unit improved respiratory outcomes in moderate to late preterm neonates with respiratory distress syndrome. This procedure was well tolerated with few adverse events. Further research evaluating the efficacy of MIST in other non-tertiary units is warranted.

Implementing a novel protocol for withdrawal of CPAP support in COVID-19 patients: a case series

No published protocol to guide the withdrawal of continuous positive airway pressure (CPAP) for patients with COVID-19 exists. Description of the introduction of a novel protocol, developed by consensus to guide the withdrawal of CPAP for patients diagnosed as dying with COVID-19 in an acute hospital. 19 patients died on the high-dependency respiratory unit following treatment with CPAP. 89% died with CPAP withdrawn. The dying trajectory was difficult to predict. Symptoms were managed promptly and effectively with a combination of opioids, benzodiazepines and close medical supervision. No concerns were raised by families regarding the decision making or withdrawal process. The use of the protocol ensures a comfortable and dignified death and supports the delivery of individualised care at the end of life. Future research on this topic should focus on qualitative outcomes and consider the applicability of this protocol in other patient groups.

IL-1 Receptor Antagonist Anakinra in the Treatment of COVID-19 Acute Respiratory Distress Syndrome: A Retrospective, Observational Study.

The IL-1 receptor antagonist, anakinra, may represent a therapeutic option for acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19). In this study, COVID-19 ARDS patients admitted to the Azienda Socio Sanitaria Territoriale of Lecco, Italy, between March 5th to April 15th, 2020, and who had received anakinra off-label were retrospectively evaluated and compared with a cohort of matched controls who did not receive immunomodulatory treatment. The primary end point was survival at day 28. The population consisted of 112 patients (56 treated with anakinra and 56 controls). Survival at day 28 was obtained in 69 patients (61.6%) and was significantly higher in anakinra-treated patients than in the controls (75.0 versus 48.2%, p = 0.007). When stratified by continuous positive airway pressure support at baseline, anakinra-treated patients' survival was also significant compared with the controls (p = 0.008). Univariate analysis identified anakinra usage (odds ratio, 3.2; 95% confidence interval, 1.47-7.17) as a significant survival predictor. This was not supported by multivariate modeling. The rate of infectious-related adverse events was similar between groups. In conclusion, anakinra improved overall survival and invasive ventilation-free survival and was well tolerated in patients with ARDS associated with COVID-19.

Oral feeding for infants and children receiving nasal continuous positive airway pressure and high flow nasal cannula: a systematic review

BackgroundThe aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure (nCPAP) or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC.MethodsA protocol was lodged with the PROSPERO International Prospective Register of Systematic Reviews. We searched Medline, Embase, CINAHL, CENTRAL and AustHealth from database inception to 10th June 2020. Study population included children (preterm to < 18 years) on nCPAP or HFNC who were orally feeding. Primary outcomes included full or partial oral feeding and oropharyngeal aspiration. Secondary outcomes examined adverse events including clinical signs of aspiration, aspiration pneumonia and deterioration in respiratory status.ResultsThe search retrieved 1684 studies following duplicate removal. Title and abstract screening identified 70 studies for full text screening and of these, 16 were included in the review for data extraction. Methods of non-invasive ventilation (NIV) included nCPAP (n = 6), nCPAP and HFNC (n = 5) and HFNC (n = 5). A metanalysis was not possible as respiratory modes and cohorts were not comparable. Eleven studies reported on adverse events. Oral feeding safety was predominantly based on retrospective data from chart entries and clinical signs, with only one study using an instrumental swallow evaluation (VFSS) to determine aspiration status.ConclusionsFindings are insufficient to conclude whether commencing oral feeding whilst on nCPAP or HFNC facilitates transition to full oral feeding without adverse effects, including oropharyngeal aspiration. Further research is required to determine the safety and efficacy of oral feeding on CPAP and HFNC for infants and children.Trial registrationPROSPERO registration number: CRD42016039325.

Management of Upper Airway Bleeding in Patients Hospitalized for SARS-COV2

Spontaneous epistaxis in patients with COVID-19 can represent a clinical challenge with respect to both the risk of contamination and the treatment options. Epistaxis (nosebleed) is a common condition overall but is relatively rare in adults and older patients. We herein present the data of 25 patients with COVID-19 who developed spontaneous epistaxis while hospitalized at Centro Médico Naval from March 2020 to April 2021. All patients received low-molecular-weight heparin during their hospital stay and required supplementary oxygen therapy either by a nasal cannula, continuous positive airway pressure or ventilatory mechanical support. In total, 12100 patients with laboratory confirmed SARS-CoV-2 infection were admitted to our hospital unit from 1 March to 31 April 2021. We only found 25 patients with epistaxis, All patients underwent anterior rhinoscopy. In all patients, the bleeding site was identified, controlled with cauterization with silver nitrate and absorbable hemostatic material. In patients with posterior epistaxis, the posterior packing was removed after 5 days. Nasal lubricants were prescribed in all patients after bleeding was controlled. All patients required suspension of anticoagulation after the bleeding event for 48 hours. Posterior, anterior and oropharyngeal epistaxis occurred in both sexes, in patients with comorbidities (Diabetes mellitus, hypertension, obesity) without statistical difference. In those patients who were on ventilatory mechanical support, they presented the same risk of epistaxis, however, with a small tendency to present greater anterior epistaxis, in the same way, those patients who presented anterior epistaxis had higher mortality.

Airway Challenges in a Preterm Neonate with Undiagnosed Complete Tracheal Rings Posted for Surgery

Preterm neonates are defined as those born before 37 weeks. The anatomical features of preterm neonates vary from that of an adult, such that they have a large tongue, an anterior funnel shaped larynx, angled vocal cords and an omega shaped epiglottis. Their physiological development also differ as they have a greater risk for apnoea of prematurity, airflow obstruction, bronchopulmonary dysplasia, low functional residual capacity and decreased transient oxygen tension. Congenital airway anomalies have a prevalence rate of 0.2-1 in 10,000 live births. Congenital Tracheal Stenosis (CTS) caused by complete tracheal rings is one of the rarest forms of all the airway anomalies that occur, which is characterised by presence of complete ‘O’ shaped cartilaginous rings of trachea devoid of a membranous part. The case discussed in the article is that of a day 26 preterm neonate with increasing abdominal distension and failure to thrive. The neonate was posted for an urgent exploratory laparotomy for abdominal decompression and ileostomy. Patient was kept on Continuous Positive Airway Pressure (CPAP) support for four days immediately after birth; however, intubation was never attempted nor required. With a history of respiratory depression and lack of history of previous intubation, difficult airway cart was kept ready prior to surgery. Supraglottic Airway (SGA) devices were at the core of airway rescue in this case of undiagnosed CTS. This case report shows how and why a preparation for difficult airway in preterm neonates is a necessity. It will provide as a guide if a similar case is encountered by the anaesthetist.

Comparison Of Less Invasive Surfactant Delivery Techniques In Respiratory Distress Syndrome

Background: This study was conducted to evaluate and compare the effectiveness of newly developed minimal invasive methods for surfactant administration (LISA by using Magill forceps, INSURE) Methods: The research was conducted on 15 patients between 685-2100 gr weight, requiring surfactant administration. Poractant alpha, dose 200 mg/kg, was administered to patients with spontaneous breathing on continuous positive airway pressure support. LISA was used to administer surfactant to 7 of 15 patients, whereas 8 of them had surfactant administered using the INSURE method. Results: The data regarding the delivery method, birth weight, gender, prenatal history, usage of steroids, APGAR scores and other data about the patients until hospital discharge were recorded. Desaturation and bradycardia for 3-4 minutes were observed in 71% (5/7) of LISA and 87.5% (7/8) of INSURE cases. Bradycardia was observed in 4 of 8 patients from the INSURE group and positive ventilation was needed. From the INSURE group, 3 patients died; one of 15 had ROP and this patient was from the INSURE group. No difference was found among the groups regarding required duration of O2 and days of hospital stay (p&amp;lt;0.05). The thin catheter group had significantly fewer median days on mechanical ventilation and lower rate of mortality (p&amp;lt;0.05). Conclusions: When there is no need for mechanical ventilation, intubation for surfactant administration was determined not to be necessary in the present study. LISA was observed to be the best method for surfactant administration among the methods without intubation.