Total Duration Of Respiratory Support Research Articles

Troponin-T value as a prognostic marker in neonates diagnosed with neonatal encephalopathy and receiving hypothermia treatment.

The aim of this study was to investigate the effect of Troponin-T levels on the prognosis of neonatal encephalopathy (NE). The study included one hundred and eleven newborns diagnosed with NE and receiving hypothermia treatment. The cases were separated into 2 groups according to the SARNAT classification as Stage 2 or Stage 3. The groups were compared in respect of anthropometric characteristics, APGAR scores, and biochemical parameters. The cases were also separated into 3 groups according to the Troponin-T levels and were compared with respect to the clinical course. The serum Troponin-T (p=0.012), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p<0.0001), and lactate levels (p=0.04) in the Sarnat Stage 3 group were statistically significantly higher than in the Sarnat stage 2 group. A significant positive correlation was determined between the Troponin-T level and the total duration of respiratory support (r=0.20, p=0.03). A significant positive correlation was determined between the ALT/AST ratio and the length of stay in hospital (r=0.29, p=0.001), duration of intubation (r=0.32, p=0.01), and total duration of respiratory support (r=0.36, p<0.001). A statistically significant difference was determined in mortality rates between the 3 subgroups of Troponin-T levels; Group 1: 2.8%, Group 2:5.4%, and Group 3: 15.8%. (p=0.04, χ²=4.74). A cut-off value of 164 ng/L for Troponin-T was determined to predict mortality with 77% sensitivity and 67% specificity (AUC=0.73, p=0.023). When the groups were compared according to Troponin-T level, a statistically significant difference was determined in respect of length of stay in hospital (p=0.03, χ²=6.95) and total duration of oxygen support (p=0.01, χ²=9.12). The serum Troponin-T level can be evaluated as a prognostic marker in cases followed up with a diagnosis of NE and receiving hypothermia treatment. There is a need for further prospective studies with larger samples on this subject.

Changes in ventilation modes in the last decade and their impact on the prevalence of bronchopulmonary dysplasia in preterm infants.

Less invasive forms of ventilation have evolved aiming to decrease bronchopulmonary dysplasia (BPD) morbidity. It is unclear whether changes in ventilation practices have been associated with improvements in respiratory outcomes. To examine the changes in ventilation modes in preterm neonates between two periods during the last decade and their impact on BPD prevalence. A retrospective chart review of very low birth weight infants and those born at less than 32 weeks gestation hospitalized during two periods: the years 2012-2013 and 2018-2019. The primary outcome was the prevalence of BPD. Study variables included the mode and duration of ventilation, duration of oxygen need, and perinatal clinical parameters. Four hundred eighty-one infants were enrolled. Between the two study periods, a significant increase was observed in invasive (33%-47%, p = 0.002), and noninvasive ventilation rates (44%-72%, p < 0.001). The average duration of noninvasive ventilation increased significantly (from 9.24 to 14.08 days, p = 0.016). The total duration of respiratory support remained unchanged. The overall prevalence of moderate and severe BPD at 36 weeks corrected age remained approximately 40% in preterm infants born at less than 28 weeks gestation. The increasing use of non-invasive ventilation was not accompanied by a reduction in the use of invasive ventilation, nor by a reduced prevalence of BPD. The high prevalence of BPD remains a significant problem in extreme prematurity. Other interventions, in addition to less aggressive ventilation, need to be explored.

Less invasive surfactant administration via infant feeding tube versus InSurE method in preterm infants: a randomized control trial

There is growing evidence that less invasive surfactant administration (LISA) is a better alternative to the standard Intubate-surfactant-extubate (InSurE) procedure in spontaneously breathing preterm infants with RDS. The infant feeding tube is easily available and cost-effective in comparison to special catheters used for surfactant administration in various studies on LISA and cost-effective health care is the need of the hour for countries like ours which are Low and middle-income countries(LMICs).The present study was planned to compare the total duration of respiratory support in preterm babies between 26 to 34 weeks of gestation with RDS requiring surfactant therapy administered by LISA technique using an infant feeding tube or InSurE method. In this unblinded randomised controlled trial, 150 infants were allocated to LISA (n = 74) or InSurE group (n = 76). An 8F feeding tube was used for surfactant delivery in the LISA group. The primary outcome was the total duration of respiratory support required and secondary outcomes included the proportion of babies developing BPD, IVH, PDA, NEC, ROP, air leaks, CPAP failure, and those requiring a repeat dose of surfactant along with the duration of hospitalization, time to regain birth weight and Death. The baseline variables including birth weight and gestation age were similar in the two groups. Nearly 27% of the mothers did not receive any dose of antenatal steroids (ANS) while around 37% of the mothers received complete course of ANS. A high proportion of babies (57%) were delivered by cesarean section. Intrapharyngeal reflux was significantly more in babies who received surfactant with the LISA method in comparison to InSurE technique (32% v/s 3%, p < 0.001). There was no statistically significant difference in the primary outcome of the total duration of respiratory support in both groups with a median duration of 120 h, 95% CI (69–235), and p = 0.618. The need for invasive mechanical ventilation was significantly lower in the LISA group (p = 0.017) with RR (95% CI) 0.498 (0.259–0.958). The rate of CPAP failure was significantly lower in the LISA group (p = 0.005) with RR (95% CI) 0.55 (0.34–0.89). In this study, the total duration of hospital stay was reduced in the LISA group (19 days) compared to InSurE group (26 days), although the same was not statistically significant. LISA with an 8F feeding tube is feasible and an effective strategy for surfactant administration which resulted in a significant reduction in CPAP failure and the need for invasive mechanical ventilation.Trial registration: www.ctri.nic.in id CTRI/2020/05/025360. Trial was registered at CTRI on 26/05/2020. First case of trial was enrolled on 28/05/2020.

Clinical Profile and Outcome of Respiratory Syncytial Virus-Infected Neonates—A Single Center Experience

Respiratory syncytial virus (RSV) has been identified as a leading cause of lower respiratory tract infections in young children and elderly. Limited data are available on the clinical profile and outcome in neonates from India. We describe clinical profile and outcome data of neonates infected with RSV. A total of 14 neonates with acute respiratory illness (ARI) requiring newborn intensive care unit (NICU) admission were tested for respiratory virus infection. All 14 (100%) tested positive for RSV-A infection. Of these positive cases, 11 (78.57%) were NICU graduates. Cough, cold, and respiratory distress was observed to be the chief complain in 13 (92.85%) neonates. All except 2 required respiratory support. Total duration of respiratory support and hospital stay was 7 (3-12) and 8 (5-14) days, respectively. All the RSV-infected patients showed complete recovery. We observed that predominantly NICU graduates were susceptible to RSV illness with a slight male preponderance. Amongst infected, majority presented with ARI requiring respiratory support. The severity was more in NICU graduates who were born very preterm.

Features of respiratory disorders and vitamin D status in preterm infants with a gestational age of more than 32 weeks

Background. Preterm infants are at high risk for respiratory distress and vitamin D deficiency, which may be associated with a need for intensive care and long-term respiratory support.&#x0D; Aim. To study the features of respiratory disorders and vitamin D status in preterm infants with a gestational age of more than 32 weeks.&#x0D; Materials and methods. The object of the study were 64 moderate and late preterm infants with respiratory disorders and their mothers. The level of 25(OH)D in cord blood serum was determined by enzyme immunoassay.&#x0D; Results. 60.9% of children were diagnosed with respiratory distress syndrome (Group 1), 39.1% had congenital pneumonia (Group 2). Mothers of all children had a high incidence of chronic diseases and pregnancy complications. Hypovitaminosis D was detected in 71.888% of newborns of both groups, mainly at the stage of deficiency. The median concentrations of 25(OH)D in cord blood serum were 15.41 [12.4934.25] ng/ml in the 1st group of newborns, and 18.42 [14.0123.44] ng/mL in the 2nd group. The need for exogenous surfactant administration and CPAP respiratory therapy is significantly higher in neonates with respiratory distress syndrome. Children with congenital pneumonia significantly more often required mechanical ventilation, and they also had a longer total duration of respiratory support in the form of humidified oxygen supplementation. The duration of inpatient treatment in children of both groups with hypovitaminosis D was significantly higher compared to newborns with adequate levels of vitamin D.&#x0D; Conclusion. Moderate and late preterm infants with respiratory problems should be identified at high risk for hypovitaminosis D, screened for blood levels of 25(OH)D, and developed optimal vitamin D supplementation regimens a promising direction to reduce the risk of preterm birth, neonatal morbidity and reduce the time of inpatient treatment of respiratory disorders.

Poractant alfa versus bovine lipid extract surfactant: prospective comparative effectiveness study.

To compare short term respiratory outcomes in preterm infants treated with bovine lipid extract surfactant or poractant alfa. Prospective comparative effectiveness cohort study of infants <32 weeks' gestational age requiring surfactant in thirteen centers. Each center provided bovine lipid extract surfactant for a set period of time in the year 2019 and then changed to poractant alfa for the remainder of the year. The primary outcome was total duration of respiratory support. 968 infants were included. 494 received bovine lipid extract surfactant and 474 received poractant alfa. No difference was observed in the total duration of respiratory support (mechanical ventilation or non-invasive) (median 38 vs 40.5 days), need to re-dose surfactant, bronchopulmonary dysplasia, survival to discharge, or length of admission. In this pragmatic study, we did not identify any difference in short term outcomes between the groups based on the type of surfactant received.

50 Poractant alfa versus bovine lipid extract surfactant for respiratory distress syndrome in preterm infants: A prospective comparative effectiveness cohort study

Abstract Primary Subject area Neonatal-Perinatal Medicine Background There is a paucity of comparative effectiveness data for bovine lipid extract surfactant (BLES) and poractant alfa (Curosurf). Objectives To compare duration of respiratory support and short-term outcomes in very preterm infants treated with bovine lipid extract surfactant and poractant alfa. Design/Methods We performed a prospective, multicentre, comparative effectiveness study. Thirteen Canadian level III neonatal intensive care units (NICUs) provided bovine lipid extract surfactant to infants born &amp;lt;32 weeks’ gestational age (GA) for a set period of time in the year 2019 (3 to 9 months), then changed to poractant alfa for the remainder of the year. The primary outcome was total duration of respiratory support (invasive and non-invasive). We utilized the Canadian Neonatal Network database for all study data. Results A total of 968 eligible infants (530 infants &amp;lt; 28 weeks’ GA and 438 infants 280-316weeks’ GA) were included, of which 494 received bovine lipid extract surfactant and 474 received poractant alfa. In unadjusted analysis, no difference was observed in total duration of any respiratory support (median 38 vs. 40.5 days). After adjusting for baseline characteristics and accounting for cluster effects, infants treated with poractant alfa spent a median of 4.16 fewer days on respiratory support (95% CI 0.05, 8.28 days). This reduction was observed in the subgroup of infants 280-316 weeks’ GA, but not in those &amp;lt; 28 weeks’ GA, and was explained by their shorter time on non-invasive respiratory support. No differences were observed in the need to re-dose surfactant, hospital mortality, bronchopulmonary dysplasia, or length of stay in NICU. Conclusion Administration of poractant alfa was associated with shorter median duration of respiratory support compared to bovine lipid extract surfactant in preterm neonates &amp;lt; 32 weeks’ GA.

Stereophotogrammetric head shape assessment in neonates is feasible and can identify distinct differences between term-born and very preterm infants at term equivalent age

The development of head shape and volume may reflect neurodevelopmental outcome and therefore is of paramount importance in neonatal care. Here, we compare head morphology in 25 very preterm infants with a birth weight of below 1500 g and / or a gestational age (GA) before 32 completed weeks to 25 term infants with a GA of 37–42 weeks at term equivalent age (TEA) and identify possible risk factors for non-synostotic head shape deformities. For three-dimensional head assessments, a portable stereophotogrammetric device was used. The most common and distinct head shape deformity in preterm infants was dolichocephaly. Severity of dolichocephaly correlated with GA and body weight at TEA but not with other factors such as neonatal morbidity, sex or total duration of respiratory support. Head circumference (HC) and cranial volume (CV) were not significantly different between the preterm and term infant group. Digitally measured HC and the CV significantly correlated even in infants with head shape deformities. Our study shows that stereophotogrammetric head assessment is feasible in all preterm and term infants and provides valuable information on volumetry and comprehensive head shape characteristics. In a small sample of preterm infants, body weight at TEA was identified as a specific risk factor for the development of dolichocephaly.

Effect of very early use of caffeine citrate in preterm neonates needing respiratory support

Abstract Background Caffeine citrate is one of the most widely used medications in neonatal intensive care units. It is a respiratory stimulant which has well established therapeutic effects in apnea and extubation. Little is known about the very early use of caffeine citrate in preterm neonates. We aim to explore the effectiveness of its very early use in reducing the duration of the respiratory support used and not just extubation. Objectives to study the effect of the very early use of caffeine citrate in preterm neonates on morbidity and short-term neonatal outcomes. Subjects and Methods A prospective phase 3 clinical trial was carried out on 54 preterm neonates less than 34 weeks of gestation who require respiratory support and were given caffeine citrate in two different settings, over a period of one year. Patients were randomly allocated to one of two groups, the first group was given caffeine citrate at initiation of respiratory support(CPAP, NIPPV and IPPV). The second group received caffeine citrate 6 hours before weaning of the respiratory support used. Caffeine citrate was stopped after complete removal of the respiratory support used. Both groups were compared as regard the duration of each respiratory support used separately and the total duration of respiratory support needed for each patient. Results The duration of IPPV used in patients was significantly lower in the patients that received early caffeine citrate. Total duration of the respiratory support needed for each patient was significantly lower in the early group. There was no significant difference in the development of complications related to the drug use between both groups. The total duration of NICU stay was significantly lower in the early group than the other group. Conclusion The Early initiation of caffeine citrate has effectively and safely decreased duration of respiratory support used and NICU stay without the development of any complications. Key words early caffeine citrate, preterm neonates, respiratory support. *CPAP: Continuous positive airway pressure NIPPV: Non invasive positive pressure ventilation IPPV: Intermittent positive pressure ventilation NICU: Neonatal Intensive care unit

Analysis of using of citicoline in term newborns during the acute period of hypoxic ischemic encephalopathy

Hypoxic ischemic encephalopathy occurs in 1.5 to 4 per 1,000 births in developed countries, and in as many as 26 per 1,000 live births in resource-limited settings. Therapeutic hypothermia significantly reduces the combined outcome of death or severe neurodevelopmental impairment from 65% to 40-50%. While the benefits of therapeutic hypothermia provide proof of concept that outcomes can be improved, additional pharmacological agents for neonatal neuroprotection for further improve outcomes of hypoxic ischemic encephalopathy are needed.Objective.To determine the potential neuroprotective influence of citicoline interm neonatesduring the acute period of hypoxic-ischemic encephalopathy.Materials and methods.A prospective, single-centered, randomized, controlled study of the citicolineimpact on acute period after perinatal hypoxia-ischemia performed in 205 full-term infant, were treated in the neonatal intensive care unit inbabiessustained of hypoxic ischemic encephalopathy in 2012-2017. Citicoline was administered basingon simple randomization in dose of 200 mg once daily intravenously for the first 5 days of treatment. Endpoints included indicators such as duration of positive pressure ventilation, total days of intensive care and the morbidity of cerebral leukomalacia, as well as frequency of the development of seizures. During all the days of the study, a standard neurosonography was performedtoevaluateresistant and pulsatile indexes in the anterior cerebral artery.Results.After randomization 31 babieswere collectedinthe groupof citicoline, remaining 174 infants were at the control group. The obtained data showed no significant differences between citicoline and control groupsin Doppler indexes on the first day of treatment, mean blood pressure, terms of extubation, and the total duration of respiratory support, both invasive and non-invasive. Interestingly, there was a significant difference on the 3rd day of treatment with the resistantindex (p=0.026) and pulsatile index (p = 0.036) measured in the anterior cerebral arteries. However, despite the more prognostic, more positive values in the citicoline group, this did not lead to a decrease in the incidence of cerebral leukomalacia, which was even lower in the control group (10.9% vs. 19.4%), but this difference was not reliable (p=0.186). On the other hand, we paid our attention to the higher frequency of the development of seizuresin the citicoline group on the 1st(p=0.005) and 2nd(p <0.001) and 3rd days of the study (p=0.003).Conclusions.Among term neonates the use of citicoline duringthe acute period of HIEdid not show neuroprotective properties.

Viral Respiratory Infections Diagnosed After PICU Admission.

Reduction of nosocomial infections represents an increasingly recognized aspect of PICU benchmarking. We investigated the prevalence and outcomes of viral respiratory infections acquired during admission to PICU. Multicenter, statewide retrospective linkage study. Tertiary PICU. All children less than 16 years requiring PICU admission for greater than 48 hours from January 1, 2008, until December 31, 2013. Testing was performed in symptomatic patients using an extended panel polymerase chain reaction capturing nine respiratory viruses. Duration of intubation and total duration of respiratory support were primary outcomes. Of 3,607 patients admitted to PICU for greater than 48 hours, 102 (2.8%) were diagnosed with a PICU-associated viral infection out of 702 patients (19.4%) undergoing viral testing, reflecting a rate of 2.8 PICU-associated viral infections per 1,000 PICU patient days. Compared with negative/untested patients, those with PICU-associated viral infections had greater intubation duration (median 164 vs 67; p< 0.001), longer respiratory support (204 vs 68 hr; p < 0.001), were more likely to require extracorporeal life support (odds ratio, 5.3; 2.7-10.3; p < 0.001), high-frequency oscillatory ventilation (odds ratio, 3.0; 1.7-5.4; p < 0.001), and inhaled nitric oxide (odds ratio, 2.7; 1.5-5.0; p = 0.001). When comparing patients with PICU-associated viral infection with patients who tested negative for respiratory viruses, no substantial difference in these outcomes was found. The acquisition of viral infections during PICU admission is less frequent compared with previous reports on bacterial and fungal hospital-acquired infections. We did not observe worse patient-centered outcomes when comparing virus positive versus tested but negative patients. Our findings challenge the clinical value of performing viral respiratory diagnostics in PICU patients evaluated for infection.

High flow nasal cannula vs non-invasive ventilation in pediatric ARDS: an RCT

Introduction: Pediatric Acute Respiratory Distress syndrome (PARDS) has been re-defined (2015) as per the final recommendations of the Pediatric Acute Lung Injury Consensus Conference. The use of high flow nasal cannula is a promising treatment but its efficacy compared with non invasive ventilation (NIV) is not known. Aims and Objectives: The current study was undertaken to study the efficacy of high flow nasal cannula compared with NIV in PARDS. Methods: This was a pilot randomized controlled trial done in the PICU of a tertiary care teaching hospital over 10 months (December 2017 – September 2018). All patients aged 1-18 years of age, who presented with or developed ARDS during their course of hospitalization, and who fulfilled the inclusion criteria, were randomized to receive HFNC and Continuous Positive Airway Pressure (NIV) as the initial respiratory support.Details were noted in a pre-designed standardized data collection form, entered into MS-EXCEL worksheet 2013 and analyzed using the Epi info software version 7.2.0.1. Results: A total of 40 patients were enrolled, 20 in each arm.Of these majority (25/40=62.5%) were boys. Majority of these patients were from rural or semi-urban areas (28/40=70.0%) and belonged to low socio-economic class (33/40= 82.5%) patients.Underlying diagnosis was sepsis in the majority (27/40=67.5%) patients.Twenty one (23/40=57.5%) patients had co-existent pneumonia.Development of hemodynamic instability approached statistical significance in being low in HFNC group compared with the CPAP group (p=0.07; OR 0.206, 95% CI 0.036-0.159).Subsequent requirement of invasive ventilation was also low in HFNC group compared with CPAP group and approached significance (p=0.09; OR 1.653, 95% CI 0.074-1.246). Total duration of respiratory support (p=0.62) was comparable in both the groups. Conclusion: HFNC is efficacious in managing PARDS. Subsequent requirement of invasive ventilation and hemodynamic deterioration was significantly low with HFNC compared with NIV (CPAP).

Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure.

AIMTo characterize the clinical course and outcomes of nasal intermittent mandatory ventilation (NIMV) use in acute pediatric respiratory failure.METHODSWe identified all patients treated with NIMV in the pediatric intensive care unit (PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers. Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included. Data included demographics, vital signs on admission and prior to initiation of NIMV, pediatric risk of mortality III (PRISM-III) scores, complications, respiratory support characteristics, PICU and hospital length of stays, duration of respiratory support, and complications. Patients who did not require escalation to mechanical ventilation were defined as NIMV responders; those who required escalation to mechanical ventilation (MV) were defined as NIMV non-responders. NIMV responders were compared to NIMV non-responders.RESULTSForty-two patients met study criteria. Six (14%) failed treatment and required MV. The majority of the patients (74%) had a primary diagnosis of bronchiolitis. The median age of these 42 patients was 4 mo (range 0.5-28.1 mo, IQR 7, P = 0.69). No significant difference was measured in other baseline demographics and vitals on initiation of NIMV; these included age, temperature, respiratory rate, O2 saturation, heart rate, systolic blood pressure, diastolic blood pressure, and PRISM-III scores. The duration of NIMV was shorter in the NIMV non-responder vs NIMV responder group (6.5 h vs 65 h, P < 0.0005). Otherwise, NIMV failure was not associated with significant differences in PICU length of stay (LOS), hospital LOS, or total duration of respiratory support. No patients had aspiration pneumonia, pneumothorax, or skin breakdown.CONCLUSIONMost of our patients responded to NIMV. NIMV failure is not associated with differences in hospital LOS, PICU LOS, or duration of respiratory support.

Abstract P-210: EPIDEMIOLOGY AND OUTCOMES OF CRITICALLY ILL CHILDREN WITH VIRAL INFECTIONS REQUIRING ADMISSION TO A PEDIATRIC INTENSIVE CARE UNIT

Aims & Objectives: Few contemporary cohorts characterize the impact of viral infections on critically ill children. We investigated epidemiology and outcomes of confirmed viral infections in children admitted to a Pediatric Intensive Care Unit (PICU). Methods Multicenter retrospective study including children <16 years non-electively admitted to PICU from January 1st 2008 until December 31st 2013. Testing was performed in symptomatic patients using an extended panel Polymerase Chain Reaction (PCR), capturing nine respiratory viruses. Patients were defined as virus positive on admission if the PCR result was positive between 72hrs prior to and 48hrs after PICU admission. Primary outcomes were PICU length of stay (LOS), duration of intubation and total duration of respiratory support (invasive and non-invasive). Results Of 6,426 non-elective admissions, 1,353 (21%) patients were virus positive. In comparison to negative/untested patients, virus positive patients had longer respiratory support duration (median 51 versus 34 hours, p<0.001), were more likely to require prolonged intubation (adjusted OR 1.5; 95%-CI 1.2–1.8, p=0.001) and high-frequency oscillatory ventilation (adjusted OR 2.6; 1.9–3.7; p<0.001), and had increased PICU LOS (median 2.1 versus 1.4 days, p<0.001). Similar findings were observed when restricting analyses to patients with acute respiratory infections (p<0.05). Adjusted mortality was comparable in multivariate analyses within the entire group, acute respiratory infections, and patients with sepsis when comparing virus positive with negative/untested patients (p>0.1). Conclusions Viral infections are common in critically ill children. The significant morbidity translates into a substantial burden for PICU healthcare systems. Research into effective antiviral agents and integrated vaccines for viral pathogens is needed.

Abstract P-446: VIRAL RESPIRATORY INFECTIONS ACQUIRED DURING PEDIATRIC INTENSIVE CARE UNIT ADMISSION

Aims & Objectives: Reduction of nosocomial infections represents an increasingly recognized aspect of Pediatric Intensive Care Unit (PICU) benchmarking. We investigated the incidence and outcomes of acquired viral respiratory infections in children admitted to a PICU with length of stay (LOS) >48 hours. Methods Multicenter, statewide retrospective study including all children (<16-years) requiring PICU admission for >48hours (1-Jan-2008 until 31-Dec-2013). Testing was performed in symptomatic patients using Polymerase Chain Reaction (PCR) capturing nine respiratory viruses. Patients were defined as having a PICU-acquired viral infection if the PCR result was positive after 48hrs of PICU admission until PICU discharge. Duration of intubation and total duration of respiratory support were primary outcomes. Results Of 3,607 patients admitted >48hours to PICU, 102 (2.8%) had a PICU-acquired viral infection, translating into a nosocomial viral infection rate of 0.9/100 PICU patients and 2.8/1000 PICU patient days. Compared to negative/untested patients with PICU LOS >48hrs, those with PICU-acquired viral infections had greater intubation duration (164 versus 67hrs, p<0.001), longer respiratory support (204 versus 68hrs, p<0.001), were more likely to require extracorporeal life support (OR 5.3;2.7–10.3; p<0.001), high-frequency oscillatory ventilation (OR 3.0;1.7–5.4; p<0.001), and inhaled nitric oxide (OR 2.7;1.5–5.0; p=0.001). In multivariate analysis adjusted for LOS, age and PIM2 score, PICU-acquired viral infections were associated with prolonged intubation (p=0.004) and longer total respiratory support(p<0.001). Conclusions The acquisition of a viral infection during PICU admission is associated with significant morbidity, translating into substantial burden to PICU health-care systems. Surveillance and preventative infection control measures for viruses should be considered in PICU quality improvement initiatives.

Cardiac Morphology and Function in Preterm Growth Restricted Infants: Relevance for Clinical Sequelae

To assess cardiac morphology and function in preterm infants with fetal growth restriction (FGR) compared with an appropriate for gestational age cohort, and to ascertain clinical correlation with neonatal sequelae. With informed consent, 20 infants born between 28 and 32 weeks of gestational age and birthweight (BW) <10th percentile were compared using conventional and tissue Doppler echocardiography with 20 preterm appropriate for gestational age infants. Total duration of respiratory support was recorded. The gestational age and BW of the infants with FGR and appropriate for gestational age infants were 29.8 ± 1.3 weeks vs 30 ± 0.9 weeks (P = .78) and 923.4 ± 168 g vs 1403 ± 237 g (P < .001), respectively. Preterm infants with FGR had significantly greater interventricular septal hypertrophy, greater free wall thickening, and lower sphericity indices (1.53 ± 0.15 vs 1.88 ± 0.2; P < .001), signifying globular and hypertrophied hearts. The transmitral E/A ratio and isovolumic relaxation time, markers of diastolic function, were significantly increased in the FGR cohort (0.84 ± 0.05 vs 0.78 ± 0.03 [P < .001] and 61.4 ± 4.1 ms vs 53.2 ± 3.2 ms [P < .001], respectively). Ejection fraction, as measured by the rate corrected mean velocity of circumferential fiber shortening was reduced (1.93 ± 0.4 circ/second vs 2.77 ± 0.5 circ/second; P < .001) in the FGR cohort. On follow-up, the total duration of respiratory support was significantly longer in the FGR cohort, and correlated with tissue Doppler E/E' (r = 0.65; P = .001), mean velocity of circumferential fiber shortening (r = -0.64; P = .001) and mitral annular peak systolic excursion (r = -0.57; P = .008). Preterm infants with FGR have altered cardiac function evident within days after birth, which is associated with respiratory sequelae.

Bronchopulmonary dysplasia associated pulmonary hypertension: Making the best use of bedside echocardiography

Pulmonary hypertension (PH) complicating bronchopulmonary dysplasia (BPD) is known though echocardiographic (ECHO) criteria and clinical relevance are unclear. An audit of infants ≤28weeks' gestational age (GA) and with ‘severe’ BPD was carried out for the period January 2014 to May 2015. Six objective ECHO markers were decided a priori. During the period, 56 infants with GA and birthweight of 26±1.4weeks and 796±190g had ‘severe’ BPD. Twenty (35%) infants had no echocardiogram performed after 34weeks' corrected GA; the remaining 36 infants had an echocardiogram at 36.7±2weeks' GA. ECHO parameters indicative of PH were noted in 22 (39.3%) infants in the overall cohort. The most common parameter was tricuspid regurgitation in 13/36 (36%) infants. The GA of infants with and without PH was comparable (25.8±1.6 vs 25.8±1.3weeks, p=0.9). The total duration of respiratory support in the BPD with PH group was significantly longer compared to those without (224±130 vs 132±82days, p=0.001). Overall, 29 (52%) infants were discharged on oxygen/respiratory support; the odds when PH was present were 2.2 (95% CI 0.8–5.7). This was not statistically significant. BPD associated PH contributes to respiratory sequelae. Objective ECHO criteria may aid ascertaining true incidence.

G388(P) Earlier extubation is associated with a reduction in early post-operative complications in children undergoing surgery for non-idiopathic spinal deformity

Introduction and aims Surgical correction of non-idiopathic spinal deformities in children presents a challenge to intensivists because of the extensive nature of the surgery and co-morbidities of the patients. The postoperative management of such patients has not been standardised. Following a review of our practice, 1 we have implemented a strategy of earlier extubation in those patients requiring post-operative ventilatory support, including increased use of non-invasive ventilation (NIV). This study aimed to assess the impact of this change in practice. Methods All patients admitted to PICU following surgery for non-idiopathic spinal deformity were identified from the PICANet database for the time periods: (1) 1.1.07–31.12.08 (n = 64) and (2) 1.9.10–31.8.13 (n = 137). Details of the post-operative courses were obtained from the hospital casenotes and the PICU clinical information system. Results The cohorts were similar with respect to age (mean (SD) 13.0(3.3) years v 12.8(4.2) years, p = 0.70), gender (male 52% v 47%, p = 0.77) and proportion of patients with neuromuscular curve (53% v 46%, p = 0.43). A similar proportion received invasive ventilation (IV) in PICU (42% v 49%, p = 0.52) but the duration of IV was significantly shorter in the more recent cohort (median (IQR) 41(77.5) hours v 20(23) hours, p = 0.004). 11(17%) patients received NIV in cohort 1 compared to 45(33%) in cohort 2 (p = 0.07). The total duration of respiratory support was reduced in cohort 2 but this did not reach statistical significance (median 4.0(8.2) v 2.4(4.6) days, p = 0.20). Postoperative complications occurred in 26(41%) cases in cohort 1 and 37(27%) in cohort 2 (p = 0.04), with a trend to reduced gastrointestinal complications in cohort 2 (16% v 9% patients, p = 0.11). Median duration of post-operative hospital admission was 9(9) days in cohort 1 and 10(6) days in cohort 2 (p = 0.50). Conclusions Early extubation, facilitated by use of NIV, is associated with a reduction in early post-operative complications. Other factors impacting the post-operative course require further study so that the pathway for these complex patients can be further refined. Reference McDougall C, McFadzean J. Post-operative respiratory support following surgery for non-idiopathic spinal deformity in children. Pediatr Crit Care Med . 2011; 12 (Suppl):A119

RESPIRATORY SUPPORT OF PRETERM INFANTS AFTER EXTUBATION: COMPARISON OF CLINICAL EFFICACY OF STANDART AND HIGH FREQUENCY NON-INVASIVE VENTILATION

In animal models nasal high frequency oscillatory ventilation appears to provide better development of immature lung causing less injury. This open randomized study compared the clinical efficacy of the standard (SV) and high frequency (HFV) non-invasive (nasal) ventilation after primary extubation of very preterm infants. The study included 24 very premature infants with birth weight ≤1500 gand respiratory distress syndrome. Before the first extubation infants were randomized into the main (n = 12) or control (n = 12) group. A certain mode of respiratory support was used according to the protocol for at least 72 hrs. The primary study outcome was the need for re-intubation within 72 hrs after the initial extubation. Mortality, incidences of bronchopulmonary dysplasia (BPD) and other important complications of prematurity were also compared in these groups. The frequency of re-intubation within the first 72 hrs. of non-invasive respiratory support was similar in both groups (41.67%). No differences were observed between the groups for the total duration of respiratory support as well. The incidence of BPD was twice higher in the group of infants who were treated using nasal HFV (main group) according to physiological definition, but this difference was not significant (2 cases (16.67%) compared to 1 case (8.33%) accordingly; p = 0.78). BPD incidences according to the clinical definition were similar in the both groups (5 cases - 41.67%). The use of high-frequency non-invasive ventilation after primary extubation of very preterm infants has no obvious clinical advantages over the extubation followed by standard non-invasive ventilation.

PS-381 Nasal High Frequency Ventilation Is Not More Effective Than Noninvasive Ventilation To Prevent Extubation Failure In Very Preterm Infants

Background In animal models nasal high frequency oscillatory ventilation appears to provide better lung development and less injury that means it could be protective against repeated need of conventional ventilation. In a randomised study we compared the clinical efficacy of nasal high frequency oscillatory ventilation (nHFOV) and nasal intermittent positive pressure ventilation (NIPPV) in prevention of repeated intubation in preterm infants with very low birth weight. Methods 24 preterm infants with birth weight Results Extubation failure rate after primary extubation was the same in the both groups – 41.67%. There was no difference in total duration of respiratory support between the groups. BPD developed in 2 infants (16.67%) in the nHFOV group and in 1 infant (8.33%) in the control group (p > 0.05). Conclusions In this study nHFOV was not found to be more effective than NIPPV in prevention of primary extubation failure in preterm infants with very low birth weight.