Management Of Respiratory Distress Research Articles

The impact of using next-generation pulse oximetry on the outcomes of preterm babies admitted to the NICU: a randomized controlled trial

The purpose of this randomized controlled trial was to investigate the influence of state-of-the-art pulse oximetry technology on the health outcomes of preterm newborns in a Neonatal Intensive Care Unit (NICU). We included preterm infants born between 24 and 36 weeks of gestation in our analysis, excluding those with significant congenital anomalies, lung malformations, congenital heart defects, or early neonatal mortality. Our study involved 52 newborns, divided into two groups: one cohort was monitored using conventional oximetry, while the other was monitored with advanced pulse oximetry technology. The baseline characteristics of both cohorts, such as gender, gestational age, birth weight, prenatal care received, and infection risk, were comparable. Both groups received standardized care based on established clinical guidelines, including feeding assistance, infection prevention techniques, thermoregulation, respiratory distress management, and parental involvement through kangaroo care. We assessed the outcomes for common neonatal issues, such as chronic lung disease, sepsis, intraventricular hemorrhage, patent ductus arteriosus, and air leak syndromes. Our results indicate that there were no statistically significant differences in the primary outcomes between the two groups, suggesting that the randomization process was effective in creating balanced comparison groups. We utilized independent samples t-tests and chi-square tests as part of our statistical framework, with a p-value of less than 0.05 indicating statistical significance. Overall, our findings suggest that the implementation of next-generation pulse oximetry equipment in the NICU for monitoring preterm infants does not significantly affect clinical outcomes compared to conventional monitoring techniques. Further research is necessary to fully evaluate the benefits and feasibility of incorporating cutting-edge oximetry technologies into newborn care procedures.

Management of respiratory distress in moderate and late preterm infants: clinical trajectories in the Neobs study

Management of respiratory distress (RD) in the extremely preterm newborn meets recommendations. Few data are available concerning the management and the clinical course of moderate and late preterms with RD. Clinical course and management among moderate (30–33 weeks (wks) of gestation) and late preterms (34–36 wks) were assessed in the Neobs study, a French neonatal observational cohort study (2018) of preterms with RD in the first 24 h of life. Clinical course was defined as stable (use of non-invasive ventilation (NIV) only), initially severe (initial use of invasive ventilation (IV)), and worsening (switch off IV after NIV support). Surfactant therapy instillation and withdrawal of all ventilator support at 72 h were recorded. Among moderate (n = 279) and late (n = 281) preterms, the clinical course was similar (p < 0.27): stable (82.1 and 86.8%), worsening (11.8% and 9.3%), and initially severe RD (6.1% and 3.9%), respectively. Surfactant was administered more frequently in the moderate versus late preterm groups (28.3% vs 16.7%; p < 0.001). The recommended surfactant dose (200 mg/kg) was administered in 53.3–83.3% of moderate and 42.1–63.2% of late preterms according to the clinical course. Withdrawal of ventilatory support at 72 h was observed in 40.0% and 70.0% of moderate and late preterms, respectively (p < 0.05), and was significantly (p < 0.001) associated with clinical course (the minus proportion among the worsening group). Conclusion: While the proportion of clinical course pattern is similar in moderate and late preterm infants, the management of RD varies with gestational age, with late preterm infants being managed later in life and moderate premature infants weaned from ventilation at a later stage.What is Known:• There is a lack of clear guidance on the management of respiratory distress (RD) in moderate-to-late preterm infants.• Neobs was a multicentre, observational study designed to characterise the real-world management of moderate-to-late preterm infants with RD in France.What is New:• Secondary analyses of Neobs study data found that ventilatory support strategies were dependent on gestational age despite a similar clinical course.• At 30–33 weeks of gestation (wks), infants were more likely to receive non-invasive ventilation at delivery, while 34–36 wks infants were more likely to be managed using a wait-and-see approach.

New Nurse Self-assessed Clinical Competence, Immersion, and Attitudes Following Virtual Reality Training on the Assessment of Pediatric Respiratory Distress

BackgroundNurse residency programs continually identify needs to enhance educational experiences for new nurses to build clinical competence when transitioning to practice. Virtual reality (VR) based education may play an important role in this experience. MethodsIn this prospective cohort educational study nurses (n = 83) participated in a VR experience on the assessment of pediatric respiratory distress and failure, followed by a survey assessing demographics, retrospective pre/post self-assessment of competence, immersion, and attitudes toward VR. ResultsThe VR curriculum significantly improved nurses’ self-assessed competence in the recognition and management of respiratory distress and failure. Participants endorsed that the VR experience mimicked real-life patient experiences, was more effective than traditional education modalities, accurately depicted, reinforced, and would influence future care of patients with respiratory distress and failure. ConclusionsFindings suggest the VR curriculum improved nurse perception of their ability to care for patients with respiratory distress and failure. VR may represent a new modality for training new nurses on the clinical assessment of respiratory distress and failure.

Evaluation of etiology and clinical spectrum of respiratory distress in neonates admitted in tertiary care NICU

Background: Neonatal period is defined as up to first 28 days of life and further divided into very early (birth to &lt;24 h), early (birth to &lt;7 days), and late neonatal period (7 days to &lt;28 days). Neonatal period is the most vulnerable period of human life as it accounts for very high morbidities and mortalities and most of these are preventable. India contributes to one-fifth of global live births and more than a quarter of neonatal deaths. Respiratory distress is most common cause of NICU admission Aim of current study was to determine the etiology of respiratory distress in neonates presenting in NICU, clinical spectrum of respiratory problems in neonates having respiratory distress and the management of respiratory distress. Methods: The present study was a prospective, observational, comparative study. This study was conducted from January 2019 to October 2019 at Mata Channan Devi hospital Janakpuri, New Delhi. 80 patients were included in this study. Results: In our study 93.75% cases of respiratory distress was of respiratory origin, while 3.75% was due to cardiac cause and 2.5% was central nervous system due to birth asphyxia and in our study group most common clinical finding of respiratory distress was tachypnea found in 97.5% of patients. Result showed, overall incidence of respiratory distress among in borns was 10.34%. In our study TTNB was most common cause of respiratory distress among new born. Conclusions: There was no significant difference of incidence in male and female babies. The etiology varies with gestational age. In spite of all advances in primary maternal care, delivery and early new born care respiratory distress is still the most common cause of morbidity and NICU admission in newborn babies.

The effect of using BCPAP in the management of Respiratory Distress

In the developing world, one of the biggest cause why infant die is respiratory distress. A noninvasive respiratory support technique called bubble continuous positive airway pressure (BCPAP) is used to treat neonates who are experiencing respiratory distress. It was originally mentioned in 1971 as a way to help premature newborns' respiration. BCPAP is a less invasive method of providing respiratory assistance to newborns than mechanical ventilation. Method: 63 babies with respiratory distress were put on BCPAP as part of a clinical trial study that was undertaken at Al-Forat Al-Awsat Teaching Hospital in An'najaf city from February 1 to June 30, 2018. Results: It was shown that although 38 patients (60.31%) with respiratory distress were helped and effectively weaned off of BCPAP, CPAP failed to help 25 patients (39.68%) with respiratory distress, and they died as a result. Conclusion: BCPAP was beneficial in treating respiratory distress.

Symptom experience and care needs of Turkish palliative care patients.

Nurses need to focus on supporting patients' quality of life, supporting their families, reducing the morbidity rate, providing psychosocial support services to improve symptom management and delivering high-quality care. This study aimed to determine the symptom experience and care needs of Turkish patients who received inpatient treatment in palliative care units. This descriptive research was conducted between May 2019 and May 2020. The study sample was composed of 200 palliative care patients selected using a convenience-purposive sampling method. The personal and disease-related characteristics were collected using the Patient Information Survey and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale. The mean age of the sample was 75±15 years, and 56.5% were women. The patients' overall quality of life scores were below average (mean 84.05±19.44). The functional wellbeing and other concerns subscales of the scale were affected the most adversely. The Physical Wellbeing subscale was affected minimally, while the Emotional Wellbeing and Social Wellbeing subscales were affected moderately. Conclusion: The palliative care patients mostly needed support for the prevention and management of infections, management of respiratory distress and swallowing problems, dealing with confusion and improving compliance with treatment. The low quality of life scores emphasise the importance of urgent interventions for improving the functional wellbeing and symptom management in these patients.

Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study

BackgroundNoninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not.MethodsThis retrospective study included patients ≥18 years old who were cared for acute respiratory distress in a prehospital setting. Indications for NIV were oxygen saturation (SpO2) <90% and/or respiratory rate (RR) >25/min with a presumptive diagnosis of APE or COPD exacerbation. Study population characteristics, initial and at hospital vital signs, presumptive and definitive diagnosis were analyzed. For patients who received NIV, dyspnea level was evaluated with a dyspnea verbal ordinal scale (D-VOS, 0-10) and arterial blood gas (ABG) values were obtained at hospital arrival.ResultsAmong the 187 consecutive patients included in the study, most (n = 105, 56%) had experienced APE or COPD exacerbation, and 56 (30%) received NIV. In comparison with patients without NIV, those treated with NIV had a higher initial RR (35 ± 8/min vs 29 ± 10/min, p < 0.0001) and a lower SpO2 (79 ± 10 vs 88 ± 11, p < 0.0001). The level of dyspnea was significantly reduced for patients treated with NIV (on-scene D-VOS 8.4 ± 1.7 vs 4.4 ± 1.8 at admission, p < 0.0001). Among the 131 patients not treated with NIV, 41 (31%) had an indication. In the latter group, initial SpO2 was 80 ± 10% in the NIV group versus 86 ± 11% in the non-NIV group (p = 0.0006). NIV was interrupted in 9 (16%) patients due to either discomfort (n = 5), technical problem (n = 2), persistent desaturation (n = 1), or vomiting (n = 1).ConclusionsThe results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies.Trial registrationThe study was approved by our institutional ethical committee (CER-VD 2020-01363).

Respiratory distress management in moderate and late preterm infants: The NEOBS Study

ObjectiveTo investigate the characteristics and management of respiratory failure (RF) in moderate-to-late preterm infants. MethodsNEOBS was a prospective, multicenter, observational study conducted in 46 neonatal intensive care units caring for preterm infants (30+0/7 to 36+6/7 weeks of gestation [WG]) in France in 2018. The cohort was stratified into two groups: 30–33 WG (group 1) and 34–36 WG (group 2). Infants with early neonatal RF were included and the outcomes assessed were maternal, pregnancy, and delivery characteristics and how RF was managed. ResultsOf the 560 infants analyzed, 279 were in group 1 and 281 were in group 2. Most pregnancies were singleton (64.1%), and 67.4% of women received prenatal corticosteroids (mostly two doses). Infants were delivered by cesarean section in 59.6% of cases; 91.7% of the infants had an Apgar score ≥7 at 5min. More than 90% of infants were hospitalized post-birth (median duration, 36 and 15 days for groups 1 and 2, respectively). Medical intervention was required for 95.7% and 90.4% of the infants in group 1 and group 2, respectively, and included noninvasive ventilation (continuous positive airway pressure [CPAP]: 88.5% and 82.9%; high-flow nasal cannula: 55.0% and 44.7%, or other) and invasive ventilation (19.7% and 13.2%). The two main diagnoses of RF were respiratory distress syndrome (39.8%) and transient tachypnea of the newborn (57.3%). Surfactant was administered to 22.5% of the infants, using the less invasive surfactant administration (LISA) method for 34.4% of the patients. In the overall population, 8.6% of the infants had respiratory and/or hemodynamic complications. ConclusionsThe NEOBS study demonstrated that CPAP was widely used in the delivery room and the LISA method was chosen for 34.4% of the surfactant administrations for the management of RF in moderate-to-late preterm infants. The incidence of RF-related complications was low.

Rapid Cycle Deliberate Practice for Pediatric Intern Resuscitation Skills.

IntroductionFor pediatric interns, it takes deliberate practice to translate the knowledge of what to do in emergencies into the procedural and communication skills required of a team member or team leader. This curriculum taught interns through simulations with rapid cycle deliberate practice (RCDP). This method focused on teaching time-sensitive team-based activities in simulation. The RCDP structure alternated practice with immediate expert feedback. This alternating pattern gave the learner chances to practice the correct way to perform these skills.MethodsThe curriculum was developed iteratively based on common gaps in intern skills and knowledge; it was well suited for groups of four to six interns and to be given by one or two instructors over a 6-hour period of time. After an initial warm-up case, a series of simulations used RCDP to move interns through cases focusing on management of respiratory distress, upper airway obstruction, shock, intubation, complications of intubation, and pulseless arrest. Feedback was interspersed throughout the experience with detailed explanations provided as the interns required them to complete the simulations.ResultsThis technique was well received by a group of 81 interns who provided positive feedback on the sessions. In particular, when asked if the course “improved my teamwork and leadership skills” they agreed with a mean score of 4.9 out of 5.DiscussionThis curriculum taught and integrated the procedural skills, communication skills, and teamwork needed to participate in pediatric resuscitations. The methods described in this curriculum improved confidence of pediatric interns and merits further study.

Effectiveness of bubble continuous positive airway pressure as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome at district level tertiary care hospital

Background: Continuous positive airway pressure (CPAP) has become a useful modality in the management of respiratory distress in preterm babies. CPAP when applied to preterm infants with respiratory distress syndrome (RDS) is associated with benefits in terms of reduced respiratory failure and reduced mortality. Objectives: The objectives of the study were to evaluate the efficacy of bubble CPAP in preterm neonates with RDS requiring respiratory support and to study the risk factors associated with its failure. Materials and Methods: A prospective observational study was done on 243 preterm neonates (gestational age [GA] 28 to ?37 weeks) with a diagnosis of RDS admitted from January 2016 to November 2017. All the eligible preterm neonates were started on bubble CPAP with binasal prongs. Surfactant was administered when indicated. Results: A total of 243 preterm neonates were enrolled in this study with a mean GA of 32.40 weeks and birth weight of 1831.49 g. One hundred and fifty-one (62.1%) were male and 92 (37.9%) were female. The mean age of starting of CPAP was 13.44 h of life and antenatal steroid coverage was 3.2% only. Of the 243 neonates, 195 neonates were successfully weaned off CPAP. Among the 48 neonates who failed CPAP, 27 neonates were ventilated, of which 20 (74.1%) survived. The predictors of CPAP failure were GA &lt;32 weeks, birth weight &lt;1.5 kg, and delayed initiation of CPAP. Conclusion: The efficacy of CPAP in neonates with mild-to-moderate RDS in preterm neonates is very well demonstrated despite the low usage of antenatal steroids, surfactant, and delayed initiation of CPAP. Extreme preterm, very low birth weight neonates with severe RDS on chest X-ray are at risk of failure of CPAP.

Comparison of the Heated Humidified High-flow Nasal Cannula with Nasal Continuous Positive Airway Pressure as Primary Respiratory Support for Preterm Neonates: A Prospective Observational Study

Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity in the management of respiratory distress in preterm neonates. However, it is not known whether it takes precedence over the gold standard nasal continuous positive airway pressure (NCPAP) in this age group as a primary mode of non-invasive ventilation (NIV). There is limited evidence addressing this issue in the literature. Therefore, this study aimed to focus on the effect of HHHFNC on preterm neonates with respiratory distress, compared to NCPAP as a primary mode of respiratory support. Methods: A prospective observational study conducted in tertiary level III NICU. The preterm neonates 28-36 weeks with respiratory distress syndrome (onset of distress within ≤4 hours of life with FiO2 ≥0.25 with compatible chest radiograph) were managed with either HHHFNC or nCPAP The need for invasive ventilation within 72 hours of initiation of non-invasive respiratory support was studied. FiO2 and Downe’s scores were recorded every 4th hour for the first 48 hours. Results: In total, 84 neonates were enrolled in this study. Treatment failure for HHHFNC group was 34.4%, whereas it was 32.2% (P=0.34) for NCPAP group which indicated no significant differences. In the late preterm strata, NCPAP group obtained longer duration for NIV (Median: 64 vs 43 hours, respectively; P<0.001); however, there were no differences between the study groups regarding the use of supplemental oxygen. The estimation of the survival time was plotted using the Kaplan-Meier curve (P<0.001). In addition, the two groups were compared through Gehan–Breslow–Wilcoxon test. Moreover, the results revealed differences between the two groups in terms of the hazards ratio for time to success regarding such items as the intervention group, gestational age, birth weight, surfactant therapy, and Downe’s score (1.17; CI: 95% [0.7, 1.8]). Conclusion: Early HHHFNC obtained similar results, compared to NCPAP as a primary mode of NIV for a preterm population with respiratory distress, and it may not be superior to NCPAP.

Efficacy and Complications of Humidified High-Flow Nasal Cannula Versus Nasal Continuous Positive Airway Pressure in Neonates with Respiratory Distress Syndrome After Surfactant Therapy

Background: Neonatal respiratory distress syndrome (RDS) is a problem that often occurs in preterm neonates. Objectives: The present study was conducted to compare the efficacy and complications of humidified high flow nasal cannula (HFNC) with those of nasal continuous positive airway pressure (NCPAP) after surfactant therapy in neonates with RDS. Methods: This clinical trial was conducted on 60 neonates with the gestational age of 28 - 36 weeks suffering from RDS and admitted to Fatemieh Hospital in Hamadan, Iran, during 2017. Initially, all newborns were administered with exogenous surfactant. Subsequently, the participants were randomly assigned into two groups of HFNC (group 1) and NCPAP (group 2) to receive respiratory support. The NCPAP group was managed with a mask or nasal prong. The HFNC group was given warm and humid oxygen through a short binasal cannula proportional to the weight of each neonate until the recovery of respiratory distress. Results: The mean one-minute Apgar scores were obtained as 6.23 ± 1.55 and 6.60 ± 1.07 in the HFNC and NCPAP groups, respectively. Furthermore, the mean five-minute Apgar scores were 8.0 ± 1.11 and 8.17 ± 0.95 in these groups, respectively. The mothers and neonates in both groups were comparable in terms of demographic and clinical data, except for gestational age and neonatal gender (P = 0.05). Furthermore, there was no statistically significant difference between the HFNC and NCPAP groups regarding the respiratory outcomes (P = 0.05). Conclusions: As the findings indicated, humidified high flow nasal cannula was as effective as nasal continuous positive airway pressure in the management of respiratory distress in premature neonates with the gestational age of 28 - 36 weeks. Consequently, these two interventions could be used interchangeably for the provision of respiratory support among these patients.

Bubble CPAP therapy for neonatal respiratory distress in level III neonatal unit in Amman, Jordan: a prospective observational study.

PurposeBubble continuous positive airway pressure (bCPAP), a noninvasive respiratory support modality used to manage newborns with respiratory distress, provides continuous pressure that helps prevent derecruitment of alveoli, increasing the lungs’ functional residual capacity, and thus decreasing the work of breathing. bCPAP can be used to manage various respiratory conditions in the newborn. In this prospective study, we describe our experience using bCPAP therapy as the primary respiratory support in a level III neonatal unit in Amman, Jordan. In addition to reporting therapeutic indications, durations, and side effects, we aimed to identify areas requiring improvement in bCPAP therapy in our population.Patients and methodsThis prospective observational study investigated the usage of bCPAP in the management of respiratory distress in newborns admitted to a Jordan University Hospital in Amman. The newborns were followed until discharge. The patients’ demographic and clinical data were recorded.ResultsA total of 143 babies (mean gestational age, 36±2.7 weeks; mean birth weight, 2,770±1,800 g) were included. All received bCPAP as the primary respiratory support. The most common underlying cause of respiratory distress was transient tachypnea of the newborn (42%), followed by prolonged respiratory transition (34%). The therapy success rate was 93.7%; only nine infants failed bCPAP. The most common side effect was physical facial injury.ConclusionThe use of neonatal bCPAP therapy is well established in Jordan University Hospital. The area of potential improvement was the low rate of bCPAP use as a primary respiratory support in extremely premature infants.

Bubble CPAP devices for infants and children in resource-limited settings: review of the literature

ABSTRACTBackground: Early management of respiratory distress is critical to reducing mortality in infants and children in resource-limited settings. Bubble continuous positive airway pressure (bCPAP) can offer effective and affordable non-invasive respiratory support.Objective: To determine the best physical components of bubble CPAP circuits for respiratory support of children in low-resource settings. Methods: Using PubMed, CINAHL and LILACS, studies of any design in any language published before June 2017 which examined the physical components of bCPAP circuits were identified and reviewed.Results: After screening, the review included 45 articles: 17 clinical trials, 11 literature reviews, 10 technical assessments of bCPAP components, three reports of real-world implementation in low-resource settings, three cost analyses and one case report. There is no ideal bCPAP circuit for all settings and patients, but some choices are generally better than others in designing a circuit for low-resource settings. Oxygen concentrators are usually the best source of oxygen. As yet, there is no affordable and accurate oxygen blender. Nasal prongs are the simplest patient interface to use with the fewest complications but are not the cheapest option. Expiratory limbs should be at least 1 cm in diameter. Home-made pressure generators are effective, safe and affordable.Conclusion: This narrative review found many studies which evaluated the real clinical outcomes with bCPAP in the target population as well as technical comparison of bCPAP components. However, many studies were not blinded or randomised and there was significant heterogeneity in design and outcome measures.Abbreviations: bCPAP, bubble continuous positive airway pressure; CPAP, continuous positive airway pressure; FiO2, fractional oxygen concentration; HFNC, high-flow nasal cannula; HIC, high-income countries; LMIC, low- and middle-income countries; NP, nasopharyngeal; O2, oxygen; PEEP, positive end-expiratory pressure; PICO, Population, Intervention, Comparison and Outcome

Respiratory Distress Management with Pulmonary Recruitment in Preterm Newborns, Preliminary Report

Respiratory Distress Management with Pulmonary Recruitment in Preterm Newborns, Preliminary Report

Paediatric airway infections

Difficulty in breathing is the commonest medical reason for paediatric attendance at emergency departments.1 Infections of the paediatric airway may combine the urgent challenge of managing airway obstruction and respiratory distress with the management of systemic infection and sepsis. While basic life support principles provide a sound framework for immediate management of respiratory distress, therapies will vary with the specific pathology encountered. It should be remembered that non-infective causes of respiratory distress may present in a similar fashion.

Outcome of preterm babies with respiratory distress syndrome on nasal CPAP

Background: Continuous positive airway pressure (CPAP) has become a useful modality in management of respiratory distress in preterm babies. Nasal CPAP was found to be safe and effective means of treating mild and moderate RDS and apnoea of prematurity; Continuous Positive Airway Pressure (CPAP) is a cost-effective and minimal invasive respiratory support for the newborn. The aim of the study was to assess whether the introduction of continuous positive airway pressure (CPAP) results in improved respiratory outcomes in preterm neonates ≤36 weeks of gestation in KIMS hospital.Methods: The study was an observational clinical study, undertaken in KIMS hospital, Bangalore, Karnataka, between November 2015 to October 2016. All babies born ≤36 weeks of gestational age with respiratory distress were included in this study. Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between two or more groups and Non-parametric setting for Qualitative data analysisResults: Seventy-seven premature newborn babies with ≤36 weeks of gestation were included in the study and were put on nasal CPAP. The incidence of CPAP failure was 22.1% (95% CI 14.27-32.54%). The proportion of neonates who required surfactant was 16.9% (10.14-26.77%) and the proportion of children who met with mortality was 6.5% (10.14-26.77%) in this study.Conclusions: Early institution of CPAP in the management of RDS in premature neonates can significantly reduce the need for mechanical ventilation (MV) and surfactant therapy.

High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial

Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has not been rigorously studied in randomised trials. We aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen. In this open, phase 4, randomised controlled trial, we recruited children aged less than 24 months with moderate bronchiolitis attending the emergency department of the John Hunter Hospital or the medical unit of the John Hunter Children's Hospital in New South Wales, Australia. Patients were randomly allocated (1:1) via opaque sealed envelopes to HFWHO (maximum flow of 1 L/kg per min to a limit of 20 L/min using 1:1 air-oxygen ratio, resulting in a maximum FiO2 of 0·6) or standard therapy (cold wall oxygen 100% via infant nasal cannulae at low flow to a maximum of 2 L/min) using a block size of four and stratifying for gestational age at birth. The primary outcome was time from randomisation to last use of oxygen therapy. All randomised children were included in the primary and secondary safety analyses. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12612000685819. From July 16, 2012, to May 1, 2015, we randomly assigned 202 children to either HFWHO (101 children) or standard therapy (101 children). Median time to weaning was 24 h (95% CI 18-28) for standard therapy and 20 h (95% CI 17-34) for HFWHO (hazard ratio [HR] for difference in survival distributions 0·9 [95% CI 0·7-1·2]; log rank p=0·61). Fewer children experienced treatment failure on HFWHO (14 [14%]) compared with standard therapy (33 [33%]; p=0·0016); of these children, those on HFWHO were supported for longer than were those on standard therapy before treatment failure (HR 0·3; 95% CI 0·2-0·6; p<0·0001). 20 (61%) of 33 children who experienced treatment failure on standard therapy were rescued with HFWHO. 12 (12%) of children on standard therapy required transfer to the intensive care unit compared with 14 (14%) of those on HFWHO (difference -1%; 95% CI -7 to 16; p=0·41). Four adverse events occurred (oxygen desaturation and condensation inhalation in the HFWHO group, and two incidences of oxygen tubing disconnection in the standard therapy group); none resulted in withdrawal from the trial. No oxygen-related serious adverse events occurred. Secondary effectiveness outcomes are reported in the Results section. HFWHO did not significantly reduce time on oxygen compared with standard therapy, suggesting that early use of HFWHO does not modify the underlying disease process in moderately severe bronchiolitis. HFWHO might have a role as a rescue therapy to reduce the proportion of children requiring high-cost intensive care. Hunter Children's Research Foundation, John Hunter Hospital Charitable Trust, and the University of Newcastle Priority Research Centre GrowUpWell.

To study the effectiveness of indigenous bubble CPAP in management of respiratory distress in newborns

Background: CPAP has become a useful in management of respiratory distress, especially in preterms. CPAP delivers a continuous distending pressure via the neonates pharynx to the upper and lower airways. The main indication for use of CPAP is RDS. Aim of study: To study the effectiveness of indigenous bubble CPAP in management of respiratory distress in newborn and to determine its outcome. Setting: Department of Pediatrics, MGM Medical College and MY Hospital, Indore during the period February-July 2005. Design: Prospective Observational Study. Method: This study was carried out on inborn neonates in the NICU of MY Hospital over a period of six months. Matched controls were taken from admissions during previous four months. It included the newborns developing respiratory distress with grunting and chest retractions within 6 hours of birth whose severity was measured by Silverman Anderson Score and oxygen saturation.Neonates with increasing Silverman Anderson Score or Oxygen saturation falling below 85%were taken on CPAP and their outcome studied. Result: There were 42 RDS cases in the study group of which 28 survived and 14 died. Indigenous BUBBLE CPAP was beneficial in managing babies with RDS. Conclusion: Indigenous BUBBLE CPAP is an effective and non-invasive way to provide ventilation in a setup with limited resources. It can be used to manage respiratory distress due to RDS, congenital pneumonia & MAS. It resulted in significant reduction in mortality but prognosis was bad in those who required CPAP >8 cm H2O.

Respiratory Distress in the Newborn: An Approach for the Emergency Care Provider

The emergency care provider has a crucial role in the evaluation and management of respiratory distress in the newborn and can see infants presenting at time of birth to many months old. Respiratory distress in the newborn is important to recognize as it can present anywhere along a spectrum of severity from tachypnea to respiratory failure. In addition, it may represent a primary respiratory disease or be the harbinger of a systemic illness or problem in another organ system. Timely assessment, recognition of signs of newborn respiratory distress, and proper newborn airway management and assisted ventilation are the key initial steps in treatment. Once the infant is stabilized, being familiar with the normal newborn physical examination and vital sign parameters as well as the pertinent historical questions to ask can help rule in or out different causes of respiratory distress and help guide definitive treatment.