Neonatal Critical Care Research Articles

Thoracic Electrical Impedance Tomography-The 2022 Veterinary Consensus Statement.

Electrical impedance tomography (EIT) is a non-invasive real-time non-ionising imaging modality that has many applications. Since the first recorded use in 1978, the technology has become more widely used especially in human adult and neonatal critical care monitoring. Recently, there has been an increase in research on thoracic EIT in veterinary medicine. Real-time imaging of the thorax allows evaluation of ventilation distribution in anesthetised and conscious animals. As the technology becomes recognised in the veterinary community there is a need to standardize approaches to data collection, analysis, interpretation and nomenclature, ensuring comparison and repeatability between researchers and studies. A group of nineteen veterinarians and two biomedical engineers experienced in veterinary EIT were consulted and contributed to the preparation of this statement. The aim of this consensus is to provide an introduction to this imaging modality, to highlight clinical relevance and to include recommendations on how to effectively use thoracic EIT in veterinary species. Based on this, the consensus statement aims to address the need for a streamlined approach to veterinary thoracic EIT and includes: an introduction to the use of EIT in veterinary species, the technical background to creation of the functional images, a consensus from all contributing authors on the practical application and use of the technology, descriptions and interpretation of current available variables including appropriate statistical analysis, nomenclature recommended for consistency and future developments in thoracic EIT. The information provided in this consensus statement may benefit researchers and clinicians working within the field of veterinary thoracic EIT. We endeavor to inform future users of the benefits of this imaging modality and provide opportunities to further explore applications of this technology with regards to perfusion imaging and pathology diagnosis.

Assessment of Nurses’ Practices toward Enteral Feeding Tube for Premature Neonates

Background: To ensure safe and successful enteral feeding, precise tube insertion in the stomach's body is critical. In fact, feeding tube malposition has been linked to gastric bleeding, aspiration, and gastro-oesophageal reflux problems. Mechanical complications such as tube obstruction, displacement, or dislodgement, as well as infection-related complications, occur infrequently as a result of formula handling, storage, and administration. Objective: This study aims to assess nurses’ practices toward enteral feeding tube for premature neonates. Methodology: This study is a complementary section of a larger study, where a quasi-experimental design using test-retest approach for study group and control group participants employed in Kirkuk City Hospitals being, evaluated in several periods, in this pare the focus is only upon the pre-test period. Data collection is done by self-administrated questionnaire form, and it was given for nurses to answer after taking their agreement. A non - probability purposive sample selected from nurses who were working at the neonatal intensive critical care units. The sample was forty nurses, (20) nurses enrolled as a control group and (20) nurses enrolled as a study group. The study group participants were exposed to an interventional program. The selection criteria included Only pediatric' nurses who have from (1-15) years of experience at critical care units. Results: The finding of this study revealed that nurses have low level of practice regarding the insertion and initiating continuous enteral feeding at the pretest. Conclusion: This study concluded that nurses at the NICU have middle to low level of practice concerning the standard procedures of insertion enteral feeding tube, and initiating enteral feeding.

Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections in Arizona Acute Care Hospitals: 2016-2020 HAI Progress Report

BackgroundSince March 2020, coronavirus disease 2019 (COVID-19) has impacted clinical practices among Arizona acute care hospitals (ACHs), potentially affecting healthcare-associated infection (HAI) rates among these facilities. The Arizona Department of Health Services (ADHS) analyzed the impact of the COVID-19 pandemic on HAI occurrence among Arizona ACHs by utilizing data from the National Healthcare Safety Network (NHSN).MethodsStandardized infection ratios (SIRs) from NHSN's National and State HAI Progress Reports (2016-2020) along with 2015 national baselines and 2020 Health and Human Services (HHS) HAI target goals were compiled to evaluate trends for central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream events, and Clostridioides difficile infections (CDI). CLABSI and CAUTI SIRs among intensive care units (ICUs), ward locations, and neonatal critical care units (CLABSI only) were also analyzed. To calculate statistical significance, 95% confidence intervals were used.ResultsAmong reporting Arizona ACHs (n= 66-71, depending on year and HAI type) from 2016-2020, all four HAI SIRs decreased significantly from 2016 through 2019—CLABSI, 32% decrease; CAUTI, 25% decrease; MRSA, 41% decrease; and CDI, 36% decrease. However, CLABSI and MRSA SIRs increased significantly (60% and 45%, respectively) during 2020. Arizona CAUTI SIRs have been statistically significantly lower than the national SIRs from 2016-2020, remaining below the HHS target goal (SIR- 0.75) even during the onset of the pandemic (Arizona 2020 CAUTI SIR- 0.64). Among reporting ICUs during 2020, the CLABSI SIR increased 176% to 1.20 (significantly higher than the 2015 national baseline) and the ICU CAUTI SIR increased 49% to 0.69.ConclusionsArizona ACH HAI incidence significantly increased during the COVID-19 pandemic, especially for CLABSIs. Future recommendations for Arizona ACHs should focus on prevention activities and interventions specific to CLABSI and CAUTI occurrence among ICUs.

The Phenotypical Profile and Outcomes of Neonates with Congenital Tracheoesophageal Fistula Associated with Congenital Cardiac Anomalies Presenting for Surgery.

(1) Background: Neonates born with oesophageal atresia and/or tracheooesophageal fistula (OA/TOF) are usually born with a multitude of other congenital anomalies, which may affect their anaesthetic care and survival to hospital discharge. We reviewed the profile and outcome of neonates with OA/TOF and associated congenital cardiac anomalies presenting for surgery at an academic hospital in South Africa. (2) Methods: A retrospective, cross-sectional analysis of all medical records of neonates who had undergone surgical repair of OA/TOF was conducted at an academic hospital between January 2015 and December 2019. Descriptive statistics were used to report the data. Comparisons in perioperative events and outcomes between those with cardiac lesions and those without were done. (3) Results: Neonates presenting for OA/TOF repair with congenital cardiac defects had an incidence of 62 [95% CI 38.5–99.8] per 1000 days since birth. In total, 45.9% had associated cardiac anomalies, with PDA and ASD as the most prevalent lesions. There were statistically significant differences in intraoperative adverse events seen in neonates with congenital cardiac lesions as compared to those without. (4) Conclusion: Despite advances in neonatal critical care and anaesthetic and surgical techniques, OA/TOF associated with congenital cardiac anomalies is still associated with high mortality rates in developing countries.

Oscillation Transmission of Modern High-Frequency Neonatal Ventilators Under Different Lung Mechanics Conditions.

High-frequency oscillatory ventilation (HFOV) is widely used in neonatal critical care, and several modern ventilators using different technologies are available to provide HFOV. These devices have different technical characteristics that might interact with patient lung mechanics to influence the effectiveness of ventilation. To verify this, we studied the oscillation transmission of 5 neonatal oscillators in a lung model mimicking the mechanical patterns commonly observed in neonatal practice. This was a benchtop, in vitro, physiological, pragmatic study using a model mimicking airways and lung of a 1-kg preterm neonate and the following patterns: normal (compliance: 1.0 mL/cm H2O, resistance: 50 cm H2O/L/s), restrictive (compliance: 0.3 mL/cm H2O, resistance: 50 cm H2O/L/s), and mixed mechanics (compliance: 0.3 mL/cm H2O, resistance: 250 cm H2O/L/s). Several permutations of HFOV parameters (variable mean airway pressure or amplitude or frequency protocols) were tested. Oscillations were measured with a dedicated pressure transducer validated for use during HFOV, and oscillatory pressure ratio (OPR) was calculated to estimate the oscillation transmission. Overall OPR (calculated on all experiments) was significantly different between ventilators and the mechanical patterns (both P < .001). Different ventilators and patterns accounted for 35.6% and 20.6% of the variation in oscillation transmission, respectively. Sub-analyses per changing amplitude or frequency protocols and multivariate regressions showed that VN500 (standardized β coefficient [St.β]: 0.548, P < .001) and Fabian HFO (St.β: 0.421, P < .001; adjusted R2: 0.615) provided the best oscillation transmission. Fabian HFO also delivered oscillations with the lowest variability when increasing amplitude. In an experimental setting mimicking typical neonatal lung disorders, the oscillation transmission was more dependent on the ventilator model than on the mechanical lung conditions at equal HFOV parameters. Fabian HFO and VN500 provided better oscillation transmission overall, and when increasing amplitude, Fabian HFO delivered oscillations with the lowest variability.

Enhanced Efficiency in Pediatric Interfacility Transport Through a Centralized Hospital System Communication Center.

Assess the implementation of a new centralized communication center and the effect on our institution's interfacility transport team's ability to respond to requests for patient transport. Retrospective review of data over 12 months prior to opening compared with 12 months after implementation of our centralized communication center. Quaternary academic pediatric hospital system with three campuses, a specialized transport team with expertise in pediatric, neonatal, and maternal-fetal critical care, and a new centralized hospital system communication center. All patients for whom transport to our hospital system was requested within the review period. Our hospital developed a multidisciplinary, centralized hub incorporating technology and integrated electronic tracking systems to coordinate real-time patient flow including intra- and interhospital transfers. One function of this center is to provide a communication center for critical care transports. Multiple new protocols and processes for transport were implemented upon opening. After implementation, total transports increased 60% (from 1,200 to >1,900 transports/yr). Team dispatch time decreased 40% from 57-34 minutes. Time from initiation of call to physician acceptance decreased 15% (median, 27-23 min). Over the same interval, there were 59% fewer lost transport opportunities. With this growth, our program was able to expand our transport program in scope and numbers. A centralized communication center for pediatric hospital patient flow that included specialized critical care patient transport has increased transport capacity and enhanced efficiency throughout our multicampus hospital system.

Determine the Rate of Harmful Maternal and Foetal Outcomes in Pregnant Adolescents

Objective: The purpose of this research is to examine whether or not adolescent pregnant women have adverse maternal and foetal outcomes. Study Design: Randomized controlled trial Place and Duration: The study was conducted at Gynaecology department of DHQ Teaching Hospital, Sargodha and DHQ Hospital Mianwali for duration of four months from August 2021 to November 2021. Material and Methods: In all, there were 84 participants in this research. Patients were between the ages of 14 and 45 years. After obtaining written agreement from patients, demographic data was collected. The patients were split into two groups, I and II, which were evenly distributed. Group I included 42 patients between the ages of 14 and 19, and Group II included 42 patients between the ages of 19 and over. Cesarean sections, instrumental deliveries, labour inductions and labour prolongations, hypertensive disorders, and other negative results were observed for the two cohorts. High rates of perinatal death and admission to the neonatal intensive care unit (NICU) were also found. SPSS 20.0 was used to analyse all of the data. Results: In group I mean age of the patients was 16.65±8.51 years and had mean BMI 20.05±6.33 Kg/m2 while in second group the mean age was 23.15±6.22 years and had mean BMI 24.7±9.51 Kg/m2. Study participants in adolescence (I) were more likely to have unfavourable foetal (perinatal death, low birth weight and low apgar score) and mother outcomes (C-section, Instrumental delivery, induction of labour, and prolonged labour) than those in the adult group (II). Conclusion: According to this research, premature neonatal critical care unit admissions and delayed intrauterine development are both on the increase. Pregnant teenagers are more likely to suffer from anaemia, a urinary tract infection, high blood pressure pregnancy, and a need for a surgical birth. Keywords: Maternal outcome, Partum haemorrhage, Fetal outcome, Pre-eclampsia,

Comparison of Bubble Continuous Positive Airway Pressure Versus Conventional Ventilation In Neonates with Respiratory Distress Syndrome

Aim: The use of positive airway pressure in babies with respiratory failure has been associated with significant reductions in respiratory failure, morbidity, and death. The two most popular CPAP techniques are bladder CPAP (B-CPAP) and ventilator-assisted CPAP (V-CPAP). We wanted to see if B-CPAP and V-CPAP have different survival rates and problems. Methods: This retrospective medical trial included 60 preterm babies between 1500- 2500 g who were hospitalized to Mayo Hospital's neonatal critical care unit for breathing difficulties between May 2019 and April 2020. Between May 2019 and April 2020, they were hospitalized for respiratory distress. The patients were allocated to therapy groups at random. To calculate and evaluate survival rates, a survival analysis was done. To compare rates of survival. The t-test for sample data was used to assess the length of supplemental oxygen, hospital stay, and cost of hospital stay. Results: At 24 hours, the predicted survival rates in the B-CPAP and V-CPAP subgroups were 100% and 78%, correspondingly. The comparable results after 48 hours were 100% and 72%. Furthermore, the V-CPAP group's hospitalization expenditures were considerably greater than the B-CPAP groups. Conclusion: Based on our findings, B-CPAP was helpful in treating newborns with breathing difficulties and reduced the hospitalization. In addition to the usual benefits, the lower cost of B-CPAP may be a factor for its widespread use when contrasted to V-CPAP. Keywords: Bubble Continuous Positive Airway Pressure, Versus Conventional Ventilation, Neonates With Respiratory.

A Nonimmune Hydrops Case.

A Nonimmune Hydrops Case.

Analysis of communication and logistic processes in neonatal intensive care unit

BackgroundIn neonatology, parents play a central role as guarantors of the new-born’s autonomy. Notifying parents about their infant’s status in neonatal critical care is an integral part of the care. However, conveying this information can be very difficult for physicians and the neonatal medical team.The objective of this work is to assess the dimensions and dynamic processes of critical care communications in neonatal intensive care in order to enhance the development of theoretical and applied knowledge of these discussions.MethodsThis qualitative, descriptive study was conducted on critical care new-borns less than 28 days-old who were hospitalized in a neonatal intensive care unit. Verbatim communications with the parents were recorded using a dictaphone.ResultsThe verbatim information had five themes: (a) critical care, (b) establishing the doctor-patient relationship, (c) assistance in decision making, (d) Socio-affective and (e) socio-symbolic dimensions. Our recordings underscored both the necessity of communication skills and the obligation to communicate effectively. Analysis of the dynamics of the communication process, according to the categories of delivering difficult information, showed few significant differences.ConclusionPhysician training needs to include how to effectively communicate to parents to optimize their participation and cooperation in managing their care.

Smith’s Anesthesia for Infants and Children, 10th Edition

Smith’s Anesthesia for Infants and Children, 10th Edition

Improving Mobilization Times of a Specialized Neonatal and Pediatric Critical Care Transport Team

ObjectivesThe Ground and Air Medical Quality Transport database identifies the average mobilization time (AMT) of the transport team as a metric for benchmarking. Our specific aim was to decrease our AMT to < 25 minutes for our expanded role, ground, nonsimultaneous transports by the end of quarter 4 of 2018. MethodsStandardization of data collection with awareness building, ambulance vendor involvement, and team-focused interventions were the different phases of project implementation. Documentation of reasons for delay was performed pre- and postimplementation. ResultsOur AMT decreased from a baseline of 30.3 minutes to 24.5 minutes after project implementation. Communication delays (19.0%), reason for delay not documented (16.5%), no team available (14.0%), rotor wing vendor delays (12.4%), and ambulance vendor delays (7.4%) were the common reasons for delay on our preimplementation Pareto analysis. Communication and pharmacy delays were the most common reasons during all 3 phases of our project. ConclusionsImplementation of the project allowed us to achieve our goal of improving our AMT. Understanding the reasons for delay is a crucial consideration, and success depends on careful change management. Further iterations will need to focus on improving communication and the pharmacy medication dispatch process.

Pravastatin effect on Obstetrics Complications Associated with Uteroplacental Insufficiency: A systematic review and Meta-Analysis

To assess statins' effect on pregnancy prolongation as well as neonatal and maternal morbidity in a distinct group of uteroplacental insufficiency disorders. Electronic databases were searched from 1953 to April 2021 for cohort studies and randomized controlled trials evaluating the effect of statins treatment on pregnancies with uteroplacental insufficiency disorders compares to control. The primary outcome was pregnancy prolongation from randomization. Secondary outcomes included neonatal parameters such as birth weight, death, and critical care unit admission, and maternal outcome occurrence as the development of preeclampsia. Pooled odds ratios were calculated using a random-effects model and meta-regression was utilized when applicable. Seven cohort and RCTs studies were included in the analysis with a total of 200 parturients with uteroplacental insufficiency disorders. Of whom, 105 were treated with pravastatin and 95 did not. Parturients that received Pravastatin showed significant prolongation of gestational age from randomization to delivery, (mean difference= 6.1 weeks, 95%CI;1.4-10.8, p=0.01, I2=98%) and less neonatal critical care unit admission (OR=0.21, 95%CI; 0.07-0.64, p=0.01, I2=32%). There was a trend in a decrease in perinatal death (OR=0.3, 95%CI;0.08-1.02, p=0.05, I2=19%), and an increase in neonatal birth weight (mean difference=771gr, CI; 2–1540, p=0.05, I2=97.4%). A new diagnosis of preeclampsia occurred less under Pravastatin treatment, yet not statistically significant (OR 0.38, CI;0.13–1.12, p=0.08, I=0%). In a meta-regression, an association between prolongation of pregnancy from randomization (R2=0.7) and birth weight (R2=0.6) to study type (RCT vs cohort) was demonstrated. No statistically significant dose-response effect or gestational age at initiation of treatment effect was found. Treatment with Pravastatin in parturients who have a high risk for developing uteroplacental insufficiency-associated disorders or have an existing preeclampsia/severe IUGR may improve their neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A national retrospective review of neonatal critical care transfers in dedicated critical care transport services in the private sector

South Africa (SA) has a shortage of dedicated neonatal critical care services, which are mostly concentrated in urban areas, thus illustrating the need for neonatal critical care transport (CCT) services. Neonates who are transported by teams without the requisite experience and knowledge in neonatal care are at risk of severe adverse events during transport. This has led to the development of dedicated CCT teams by some emergency medical services. There is a paucity of national literature describing the neonatal population who undergo CCT in dedicated services.To describe a sample of neonates who underwent CCT transfer by dedicated CCT services in the private sector in SA.This observational cohort study with a retrospective descriptive design sampled all neonatal transfers completed during 1 year (1 January 2017 - 31 December 2017) from the dedicated CCT of the two largest national emergency medical services in SA. Data were extracted from patient report forms by trained data extractors, and subjected to descriptive analysis.A total of 444 neonates were transferred between the two services. A total of 760 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent diagnosis was respiratory distress syndrome (n=139, 31%), followed by congenital heart defects (n=123, 28%) and prematurity (n=81, 18%). Patients had an average of ~4 attachments, with the most prevalent being patient monitoring (n=677, 152%). Just under half (n=182, 41%) of patients required ventilatory support. A total of 422 medications were required during transport, yielding a rate of ~1 medication or infusion per neonate transported. The most common infusion was maintenance (n=199, 45%), while almost 1 in 10 neonates required inotropic support (n=33, 7%).This study provides insight into the demographics, most prevalent diagnoses, and interfacility transfer monitoring needs of neonates being transported in SA by two private dedicated CCT services. The results of this study should be used to inform future specialised neonatal CCT courses and qualifications, as well as the scopes of practice of providers transporting neonates.

MANAGEMENT OF TYPE A DISSECTION IN PREGNANCY: SITE AND TEAM CAN MAKE THE DIFFERENCE

Introduction Aortic dissection is rare in pregnancy but associated with poor maternal and neonatal outcomes. We present a case of delayed diagnosis of type A aortic dissection in pregnancy in a previously healthy woman to raise awareness and highlight the value of an integrated, multidisciplinary approach. Methods A 38-year-old, G1P0 woman was transferred to our hospital with a type A aortic dissection diagnosed at 30 weeks of pregnancy. The patient had no significant medical history and her pregnancy was uneventful. At 29 weeks gestation, however, she developed central chest pain. Her local hospital excluded a diagnosis of pulmonary embolism and discharged her home. She represented 3 days later with shortness of breath and orthopnoea. On the second day of this admission, Type A aortic dissection was diagnosed on computed tomography of the chest. She was transferred to our hospital for access to multiple specialist services including cardiothoracic surgery and high-risk obstetrics, neonatal and adult critical care. On arrival, an ad hoc MDT convened in the emergency department by a senior team of cardiothoracic surgeons, obstetricians, anaesthetists and neonatologists agreed immediate intervention was required. She went directly to theatres for delivery of the baby and dissection repair. Awake establishment of invasive blood pressure monitoring was followed by an opiate-based cardiostable induction of anaesthesia and intubation in a head-up position. The caesarian section was uneventful and exceptional measures to minimise blood loss were not required. The ascending aorta and hemi-arch were repaired on cardio-pulmonary by-pass with circulatory arrest time of 19 minutes without intraoperative complications. The baby was electively intubated and transferred to neonatal ICU in stable condition. Mother and baby were both extubated the following day and discharged home after a week. Discussion Acute aortic dissection should always be included in the differential of acute chest pain in pregnant women. It most commonly occurs during the third trimester or the early postpartum period and it can sometimes present in women with no previous history of aortopathy. High clinical suspicion, careful history taking and examination, CT, MRI or echocardiography can establish the diagnosis. Optimum management to ensure the survival of both mother and fetus varies with gestational age and planning to ensure this requires a complex balance of expertise between specialities. In the third trimester, emergency delivery followed by surgical aortic repair probably offers the best survival chances for both. Institutions which offer senior input from multiple specialities are crucial for the timely management of these complex cases. This need for urgent intervention from outside cardiothoracic surgery in cases with multiple issues must be considered when regional care models for the management of aortic dissection cases are being designed.

Increasing the Registered Dietitian Full-Time Equivalents to the Neonatal Critical Care Unit Improved Incidence of Growth Outcomes in Preterm Infants

Increasing the Registered Dietitian Full-Time Equivalents to the Neonatal Critical Care Unit Improved Incidence of Growth Outcomes in Preterm Infants

From Neonatal Intensive Care to Neurocritical Care: Is It Still a Mirage? The Sicilian Multicenter Project.

Background Neonatal brain injury (NBI) can lead to a significant neurological disability or even death. After decades of intense efforts to improve neonatal intensive care and survival of critically ill newborns, the focus today is an improved long-term neurological outcome through brain-focused care. The goal of neuroprotection in the neonatal intensive care unit (NICU) is the prevention of new or worsening NBI in premature and term newborns. As a result, the neonatal neurocritical care unit (NNCU) has been emerging as a model of care to decrease NBI and improve the long-term neurodevelopment in critically ill neonates. Purpose Neurocritical care (NCC) Sicilian project includes three academic sites with NICU in Sicily (Catania, Messina, and Palermo), and its primary goal is to develop neurocritical neonatal care unit (NNCU). Methods In 2018, the three NICUs created a dedicated space for neonates with primary neurological diagnosis or at risk for neurological injuries—NNCU. Admission criteria for eligible patients and treatment protocols were created. Contact with parents, environmental protection, basic monitoring, brain monitoring, pharmacological therapy, and organization of the staff were protocolized. Results Evaluation of the efforts to establish NNCU within existing NICU, current protocols, and encountered problems are shown. Implications for Practice. Our outcome confirmed the need for dedicated NNCU for neuroprotection of critically ill neonates at risk for a neurological injury. Although the literature on neonatal neurocritical care is still scarce, we see the value of such targeted approach to newborn brain protection and therefore we will continue developing our NNCU, even though there have been problems encountered. The project of building NNCU will continue to be closely monitored. Conclusions The development of our neonatal neurocritical model of care is far from being completed. Although it is currently limited to the Sicilian area only, the goal of this paper is to share the development of this multicenter interdisciplinary project focused on a newborn brain protection. After evaluating our outcome, we strongly believe that a combined expertise in neonatal neurology and neonatal critical care can lead to an improved neurodevelopmental outcome for critically ill neonates, from the extremely preterm to those with brain injuries.

Advances in Neonatal Critical Care: Pushing at the Boundaries and Connecting to Long-Term Outcomes.

Advances in Neonatal Critical Care: Pushing at the Boundaries and Connecting to Long-Term Outcomes.

Comparison Between Nasal High-Frequency Oscillatory Ventilation And Nasal Continuous Positive Airway Pressure In The Management Of Respiratory Distress Syndrome

Context: A neonatal respiratory distress syndrome occurs at or soon after delivery (<24 hours). Premature newborns with respiratory distress syndrome (RDS) often need breathing assistance. There has been a tendency to reduce in the previous decade the use of non-invasive ventilation modes (NIV) in neonatal intensive care units to prevent ventilator-induced lung damage, in particular after recent data showing NIV in preterm babies has equivalent efficiency compared to EMV. In practical practise, different forms of NIV may be employed include nasal continuing positive airway pressure and noninvasive intermittent positive airway pressure. Nasal continuous positive airway pressure is one of the most often utilised non-invasive techniques (NCPAP). Although HFV has been used in several neonatal critical care units, a relatively novel modality of nasal high frequency oscillatory ventilation (nHFOV) is limited in evidence of its utility. The objective of this research has been to examine the effectiveness and safety of nasal oscillatory ventilation with nasal airway continuous pressure in preterm baby respiratory distress syndrome therapy. Methods: This research is a (60 instances) clinical experiment conducted with respiratory distress syndrome (admitted to the Benha University Hospital Neonatal Intensive Care Unit and Benha Kids Hospital) between the 1–28 day age range. Cases were randomly picked in two groups: Group I: 30 instances of high-frequency oscillatory nasal ventilation were treated (nHFOV). Group II: 30 individuals with constant nasal airway pressure were treated (NCPAP). Methods: Detailed history of medicine. Total usage time NHFV and NCPAP usage time and oxygenation time required for each instance. Complication detection occurs during non-invasive breathing (pulmonary air leak syndrome, IVH, nasal injury and other.) Studies of imagery. Outcomes: There was no statistically significant difference in demographic data between the two groups. There was a statistically significant difference in IVH complication between Group I and Group II. The percentage of nasal septal injuries in Group I was significantly lower than in Group II. The rate of intervention failure (intubing and ventilator demand) in Group I was significantly lower than in Group II (3.3 percent, (26.6 percent) p value=0.030. Conclusion: High frequency nasal ventilation has a greater impact than continuous airway pressure on infants and is less complicated. This research revealed that the length of non-invasive respiratory support was greatly shortened by high frequency nasal ventilation and the necessity for intubation was minimised compared to the continuous positive airway pressure of RDS infants.

"Playing it SAFE in the NICU" SAFE-R: a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU.

Rapid diagnosis of sudden, unexpected, and potentially fatal complications in the neonatal intensive care unit (NICU) is essential for the initiation of prompt and life-saving management. Point-of-care ultrasound (POCUS) protocols are widely used in adult emergency situations to diagnose and guide treatment, but none has been specifically developed for the neonate. We propose a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU for rapid screening for the most common life-threatening complications needing immediate attention. We integrated current knowledge on the use of POCUS for diagnosis of the most critical neonatal complications into the “SAFE-R protocol” (Sonographic Assessment of liFe-threatening Emergencies — Revised). The ultrasound algorithm was evaluated at the bedside for suitability and ease of use. Main features of SAFE-R are the use of standardized ultrasound points and a simple one-probe rule-in/rule-out approach. The flowchart is designed by order of urgency and priority is given to treatable causes. Hence, ruling out cardiac tamponade is the first step in the decision tree, followed by pneumothorax, pleural effusion, then acute critical aortic occlusion, acute abdominal complications, and severe intraventricular hemorrhage.Conclusion: SAFE-R is the first ultrasound algorithm specifically conceived for use in the NICU to screen for the most common urgent neonatal complications leading to sudden deterioration, thereby providing critical information within minutes. The simplified and rapid approach is designed for the neonatologist and is easy to learn and quick to perform. What is Known:• The fields of neonatal and pediatric critical care are undergoing a transformation with the adoption of POCUS and the recent publication of the first international guidelines on POCUS for critically ill children and neonates.• Targeted emergency ultrasound protocols are widely used in adult emergency and critical care medicine, but specific and adapted ultrasound algorithms are lacking for the pediatric and neonatal population.What is New:• We propose the first targeted ultrasound protocol specifically designed for the suddenly decompensating infant in the NICU for rapid screening of the most common life-threatening complications needing immediate attention.• The SAFE-R ultrasound algorithm integrates current knowledge on ultrasound diagnosis of the most critical neonatal complications into a simple and easy-to-perform emergency scanning protocol aimed to guide initial management and resuscitation efforts.