Neonatal Ventilation Research Articles

370 Developing a Digitally Integrated Endotracheal Tube for Neonates to Improve Safety and Respiratory Function

OBJECTIVES/GOALS: Neonatal endotracheal tubes (ETTs) are usually uncuffed to avoid subglottic stenosis and other complications, but cuffed ETTs allow better ventilation. Our goal was to detect and control pressure in the cuff below the limit of occluding venous flow to minimize the risk of subglottic stenosis. METHODS/STUDY POPULATION: We designed a pressure sensor to fit on a 2.5 ETT for prototype testing in 8 age adult female rabbits. Eight uncuffed age- and sex- matched rabbits served as control. Study duration was 2 hours during which pressure in the cuff was limited by novel sensor (intervention) or auscultation (control). Anesthesia was maintained with sevoflurane. Ventilation was provided mechanically. Subsequently the tracheae were removed, sectioned crosswise, and compared histologically for mucosal damage. RESULTS/ANTICIPATED RESULTS: Preliminary data demonstrated an almost 30% greater amount of intact mucosa in the intervention group. The sensor also provided data on heart rate and respiratory rate, although this signal was not optimal. After filing an invention disclosure and provisional patent, we are refining our device to include multiple compartments for local control of cuff pressure and applying for a STTR Phase I/II application. DISCUSSION/SIGNIFICANCE: Ventilation in neonates with uncuffed ETTs can be suboptimal due to leak around the tube, but cuffed ETTs pose the threat of subglottic stenosis and other complications. We have designed a prototype cuffed ETT with a sensor to maintain low cuff pressure while preventing leaks and largely avoiding damage to the tracheal mucosa.

312 Developing a Digitally Integrated Endotracheal Tube for Neonates to Improve Safety and Respiratory Function

OBJECTIVES/GOALS: Neonatal endotracheal tubes (ETTs) are usually uncuffed to avoid subglottic stenosis and other complications, but cuffed ETTs allow better ventilation. Our goal was to detect and control pressure in the cuff below the limit of occluding venous flow to minimize the risk of subglottic stenosis. METHODS/STUDY POPULATION: We designed a pressure sensor to fit on a 2.5 ETT for prototype testing in 8 age adult female rabbits. Eight uncuffed age- and sex- matched rabbits served as control. Study duration was 2 hours during which pressure in the cuff was limited by novel sensor (intervention) or auscultation (control). Anesthesia was maintained with sevoflurane. Ventilation was provided mechanically. Subsequently the tracheae were removed, sectioned crosswise, and compared histologically for mucosal damage. RESULTS/ANTICIPATED RESULTS: Preliminary data demonstrated an almost 30% greater amount of intact mucosa in the intervention group. The sensor also provided data on heart rate and respiratory rate, although this signal was not optimal. After filing an invention disclosure and provisional patent, we are refining our device to include multiple compartments for local control of cuff pressure and applying for a STTR Phase I/II application. DISCUSSION/SIGNIFICANCE: Ventilation in neonates with uncuffed ETTs can be suboptimal due to leak around the tube, but cuffed ETTs pose the threat of subglottic stenosis and other complications. We have designed a prototype cuffed ETT with a sensor to maintain low cuff pressure while preventing leaks and largely avoiding damage to the tracheal mucosa.

Positive versus negative pressure during removal of endotracheal-tube on prevention of post-extubation atelectasis in ventilated neonates: A randomized controlled trial

BackgroundPost-extubation-atelectasis (PEA) is a common problem after the removal of an endotracheal tube in neonates which increases the rate of extubation failure. Different techniques have been introduced for the prevention of PEA. One technique is the removal of the endotracheal tube by negative or positive gradients of pressure. No RCT has yet been done to compare the use of these two methods in neonates. So this study aimed to compare the role of positive and negative pressure during extubation of neonates on the prevention of PEA. Materials and methodsWe enrolled 100 newborns in this RCT that required at least 24 h of mechanical ventilation. The endotracheal tube in one group was removed by a T-Piece resuscitator at a PEEP level of 5 CmH2o while in another group extubation was done applying suction pressure of 100 mmHg by random selection. Prevalence of PEA in CXRs after extubation was compared between the two groups. ResultsThe prevalence of PEA in the extubation of the positive pressure group (24%) was significantly lower than that of the negative pressure group (46%) (p = 0.024). Extubation failure was found to be lower in the positive pressure group (6% versus 20% P = 0.037). No significant difference was observed between the two groups in the prevalence of apnea, pneumothorax, and death at 3 days after extubation. ConclusionThe use of positive pressure during removal of the endotracheal tube in newborn infants reduced the rate of PEA compared with the negative pressure so extubation by a positive pressure is recommended in neonates.

PREVALENCE OF POTENTIALLY CLINICALLY RELEVANT COMPLEX EPISODES OF EXTREME SpO2 DURING MANUAL AND AUTOMATIC CONTROL OF INSPIRED OXYGEN

Continuous monitoring with pulse oximetry is the standard of care for titrating inspired oxygen in the neonatal ICU. However titrating supplemental oxygen to address frequent desaturations is a challenging task for caregivers. Increasing exposure to SpO2 extremes is associated with increasingly poorer long-term outcomes. More recently the prevalence of prolonged episodes at extremes and cluster of short episodes have been reported to be also associated with bad outcomes. We speculated that more complex episodes might also have an impact on outcomes. We defined two sets of these: clusters and swings. Automatic control of inspired oxygen based on continuous pulse oximetry, is available on many neonatal ventilators. Some have expressed concern that continuous adjustment of inspired oxygen, without observing the infant, might cause instability and thus increased prevalence of clusters and oscillations. The aim of this study was to determine the prevalence of these complex events and determine if they were more common during automated control. To accomplish this we analyzed data of 58 extremely preterm newborns that were ventilated at least 24 hours with manual inspiratory oxygen control and at least 24 hours with automated FiO2 control, in random order. We found that clusters and swings were quite prevalent, that is similar to the prevalence of prolonged episodes that have been shown to be associated with bad outcomes. We also found that these complex events were reduced during automated control, rather than increased. Finally, we suggest that additional research in this area is warranted.

Factors associated with initial tidal volume selection during neonatal volume-targeted ventilation in two NICUs: a retrospective cohort study.

ObjectiveTo quantify initial tidal volume (VT) during neonatal volume-targeted ventilation (VTV) and to characterize the agreement of initial VT with the limited-evidence available.Study designWe performed a multi-center retrospective observational cohort study in two Neonatal Intensive Care Units evaluating 313 infants who received VTV as the initial ventilation modality prior to postnatal day 14. We generated descriptive statistics and performed multivariable logistic regression analysis to determine factors associated with initial VT use that agreed with available literature.Results154 (49%) infants received an initial VT of 5.0 mL/kg (median 5.0 mL/kg, IQR 5.0–5.1). 45 (14%) infants received an initial VT that was congruent with available literature. A birth weight of 700 –<1250 g was significantly associated with an initial VT in agreement with VT literature (aOR 9.4, 95% CI 1.7–50.4).ConclusionsMost infants receive an initial VT of 5.0 mL/kg.

Research Priorities for Pediatric Intensive Care Nutrition Within the United Kingdom: A National Institute of Health Research James Lind Alliance Priority Setting Partnership.

OBJECTIVES:To determine research priorities in PICU nutrition, which represent the shared priorities of patients, parents, carers, and PICU healthcare professionals within the United Kingdom.DESIGN:A national multiphase priority setting methodology in partnership with the James Lind Alliance delivered over 16 months (June 2020–September 2021). Part 1: a national scoping survey asked respondents to submit their research uncertainties related to PICU nutrition. Part 2: summarizing and evidence-checking the submitted uncertainties. Part 3: interim prioritization survey. Part 4: consensus workshop.SETTING:PICU.PARTICIPANTS:Patients, parents, and carers of patients who had been admitted to PICU, and PICU healthcare professionals involved in the treatment of these patients within the United Kingdom.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:A national scoping survey asked respondents to submit their research uncertainties related to PICU nutrition. In the first survey, 165 topic ideas were suggested (12% by parents/carers and 88% by PICU healthcare professionals). These were categorized into 57 summary questions. The existing evidence was searched to ensure that the proposed summary questions had not already been answered. Forty were judged to be true uncertainties following a systematic literature review. These 40 uncertainties were grouped into eight themes for the second interim survey, which asked respondents to prioritize their top research questions. One hundred and forty participants contributed to this second interim survey. A final shortlist of 25 questions was derived, with the top 18 questions taken to a multistakeholder workshop where a consensus was reached on the top 10 priorities.CONCLUSIONS:This research identified important research gaps in the management of patients in PICU. Areas that need to be addressed as a priority include energy requirements in ventilated neonates, nutritional supplementation of probiotics to manage and prevent sepsis, the impact of postintensive care syndrome on nutrition and growth, and when to commence parenteral (IV) nutrition. The challenge now is to refine and deliver answers to these research priorities.

Use of a Novel Manikin for Neonatal Resuscitation Ventilation Training.

All providers who attend deliveries independently should be well versed in the performance of effective ventilation, assessment of the quality of ventilation/interventions supplied and able to troubleshoot in situations where these may be ineffective. A novel manikin serves as a unique ventilation-focused training tool to practice these clinical skills and decision-making. The data generated by the manikin, with the aid of a facilitator, may be used for formative and summative feedback on an individual level or curricular development on a larger level. This communication describes the importance of focused ventilation training for front-line providers and illustrates how this manikin can be incorporated into an individualized ventilation training program.

Factors affecting the arterial to end-tidal carbon dioxide gradient in ventilated neonates

Objective. To determine factors which influenced the relationship between blood carbon dioxide (pCO2) and end-tidal carbon dioxide (EtCO2) values in ventilated, newborn infants. Furthermore, to assess whether pCO2 levels could be predicted from continuous EtCO2 monitoring. Approach. An observational study of routinely monitored newborn infants requiring mechanical ventilation in the first 28 d after birth was undertaken. Infants received standard clinical care. Daily pCO2 and EtCO2 levels were recorded and the difference (gradient: ∆P-EtCO2) between the pairs were calculated. Ventilatory settings corresponding to the time of each blood gas assessment were noted. End-tidal capnography monitoring was performed using the Microstream sidestream Filterline H set capnograph. Main results. A total of 4697 blood gas results from one hundred and fifty infants were analysed. The infants had a median gestational age of 33.3 (range 22.3–42.0) weeks and birth weight of 1880 (395–5520) grams. Overall, there was moderate correlation between pCO2 and EtCO2 levels (r = 0.65, p < 0.001). The ∆P-EtCO2 for infants born less than 32 weeks of gestation was significantly higher (1.4 kPa) compared to infants born at greater than 32 weeks of gestation (0.8 kPa) (p < 0.001). In infants born at less than 32 completed weeks of gestation, pCO2 levels were independently associated with EtCO2, day after birth, birthweight and fraction of inspired oxygen (FiO2) (model r 2 = 0.52, p < 0.001). Significance. The results of end-tidal capnography monitoring have the potential to predict blood carbon dioxide values within the neonatal population.

Development of a 3D Individualized Mask for Neonatal Non-Invasive Ventilation.

Non-invasive masks are designed based on generic facial models; therefore, difficulties in fitting patients’ unique characteristics are common. A poor fit of the mask may have consequences such as air leaks or pressure ulcers. It is possible to optimize the fit of interfaces by adapting them to a patient’s face. Our objective is to design an individualized silicone mask for non-invasive ventilation for a premature phantom using a three-dimensional (3D) scanner and bioprinter. The facial surface of the manikin was scanned with a 3D scanner in a supine position, in an incubator with a sliding mattress and in <2 min. We printed the tailor-made mask in 3 h with biocompatible and hypoallergenic silicone. When applied under a simulated clinical scenario, the mask possessed good structural reliability after post-processing and optimal mechanical features. We observed adequate thoracic excursion and 14% reduction in air leaks when the manikin was ventilated with the customized mask with a neonatal ventilator. We ink the edges of personalized and standard masks. After fitting them to phantoms, personalized mask showed better pressure distribution. Our subsequent research direction is to test the viability of personalizing non-invasive ventilation masks for very preterm infants of our department.

Novel use of balloon-tipped bronchial blockers to occlude neonatal tracheoesophageal fistula: a case series

BackgroundManagement of the airway and ventilation in neonates with a tracheoesophageal fistula (TEF) remains a significant challenge. The routine method of intubation involves placement of the tracheal tube tip beyond the fistula opening followed by isolation of the fistula from ventilation using the inflated cuff. When the fistula opening is close to the carina or below the level of the carina, the traditional technique is not suitable for adequate ventilation. Moreover, this method fails to prevent gastric insufflation.Case presentationWe herein report a series of 10 newborns with TEFs (1,090–3,080 g) who underwent bronchoscopic insertion of a 5-Fr balloon-tipped bronchial blocker (BTBB) for temporary occlusion of the fistula. In seven newborns, placement of the BTBB was easily and quickly achieved with no incorrect placements. In addition, we successfully utilized the inner hollow cavity of the BTBB for gastric decompression in six neonates with severe gastric distension. However, three failed placements occurred in premature infants (<2,000 g) because the narrow cricoid cavity was too small to accommodate a 2.8-mm fiberoptic bronchoscope and a BTBB. The procedure was well tolerated by all infants, and no significant adverse events occurred.ConclusionsOur findings illustrate that BTBBs can provide durable blockage of the fistula opening and should be considered as a treatment modality for infants with large carinal TEFs. Moreover, BTBB placement is neither arduous nor time-consuming. The hollow center, small round balloon, and 30-degree angled tip of the BTBB make this device feasible for clinical application, especially for neonates with severe gastrointestinal distension.

Adverse perinatal outcomes of chlamydia infections: an ongoing challenge.

Chlamydia trachomatis is one of the most common sexually transmitted diseases in the world, but there are limited data on its impact on perinatal outcomes. Our objective was to investigate the association between chlamydia infections and adverse perinatal outcomes. This is a retrospective analysis of the United States Centers for Disease Control and Prevention natality live birth database for the years 2016-2019. The rates of adverse perinatal outcomes were compared between patients with a chlamydia infection during pregnancy andpatients without such infection, using Pearson's chi-square test with the Bonferroni adjustment. A multivariate logistic regression was then used to adjust outcomes for potential confounders. Chlamydia infections were associated with small, but statistically significant, increased odds of preterm birth(<37weeks), early preterm birth (<32weeks), low birthweight (<2,500g), congenital anomalies, low 5-min Apgar score (<7), neonatal intensive care unit admission, immediate neonatal ventilation, prolonged (>6h) neonatal ventilation, and neonatal antibiotic treatment for suspected sepsis. Chlamydia infections during pregnancy are associated with adverse perinatal outcomes. These results call for increased education regarding the potential risks of pregnancies with a chlamydia infection, as well as for increased antenatal surveillance and post-natal pediatric assessment in these pregnancies.

ALPS Trial Dissemination: Effects on Pregnant People with Diabetes and their Infants

To examine the effects of the Antenatal Late Preterm Steroids (ALPS) trial on late preterm steroid use and neonatal assisted ventilation rates among people with diabetes. Interrupted time series analysis of singleton, liveborn, non-anomalous infants born between 34-36 weeks to women with pre-existing or gestational diabetes using US birth certificate data. The period from Feb 2016 (ALPS trial publication) to Oct 2016 (updated ACOG Committee Opinion publication) was considered the dissemination period. We examined the change in late preterm steroid use and rates of 1) any assisted ventilation and 2) assisted ventilation for >6 hours. Monthly rates before and after the dissemination period were compared between Jan 2014 and Dec 2019, controlling for seasonal variation in the outcomes and monthly distribution of deliveries by week of gestation. 143,707 women with diabetes gave birth during the analysis period; 20.2% of this cohort had pre-gestational diabetes. Figure 1 shows the unadjusted monthly rates of steroid administration and assisted ventilation use in this population and the adjusted linear pre- and post-dissemination period trend. After the ALPS trial publication and the dissemination period, there was an immediate 8.77-percentage point (pp) increase in late preterm steroid use (95% CI 7.76, 9.79). There was no significant change in the rate of assisted ventilation (0.42-pp decrease; 95% CI -1.29, 0.46) or assisted ventilation for more than 6 hours (0.36-pp increase; 95% CI -0.21, 0.94). Similar findings were seen in the subgroup of women with pre-gestational diabetes. The rate of late preterm steroid administration among this population increased substantially after the trial’s dissemination without observable improvement in neonatal assisted ventilation rates. Given the underlying risk of hypoglycemia in the infants of people with diabetes, further research is needed to assess the benefits and potential risks of late preterm steroid administration in this population.

Ventilation-induced epithelial injury drives biological onset of lung trauma in vitro and is mitigated with prophylactic anti-inflammatory therapeutics.

Mortality rates among patients suffering from acute respiratory failure remain perplexingly high despite the maintenance of blood oxygen homeostasis during ventilatory support. The biotrauma hypothesis advocates that mechanical forces from invasive ventilation trigger immunological mediators that spread systemically. Yet, how these forces elicit an immune response remains unclear. Here, a biomimetic in vitro three‐dimensional (3D) upper airways model allows to recapitulate lung injury and immune responses induced during invasive mechanical ventilation in neonates. Under such ventilatory support, flow‐induced stresses injure the bronchial epithelium of the intubated airways model and directly modulate epithelial cell inflammatory cytokine secretion associated with pulmonary injury. Fluorescence microscopy and biochemical analyses reveal site‐specific susceptibility to epithelial erosion in airways from jet‐flow impaction and are linked to increases in cell apoptosis and modulated secretions of cytokines IL‐6, ‐8, and ‐10. In an effort to mitigate the onset of biotrauma, prophylactic pharmacological treatment with Montelukast, a leukotriene receptor antagonist, reduces apoptosis and pro‐inflammatory signaling during invasive ventilation of the in vitro model. This 3D airway platform points to a previously overlooked origin of lung injury and showcases translational opportunities in preclinical pulmonary research toward protective therapies and improved protocols for patient care.

Use of lung ultrasound and and aEEG patterns to predict the need for mechanical ventilation and the readiness for extubation in neonates with respiratory distress

Objective. The aim of the study was to establish if lung ultrasound findings could anticipate the need for intubation and mechanical ventilation in neonates with respiratory distress and if lung ultrasound and aEEG criteria could be used in appreciation of the readiness for extubation of the neonatal patients resulting in a decrease of the rate of extubation failure. Material and method. There were analyzed the cases of 50 late preterm and early term neonates presenting with respiratory distress. Lung ultrasound was performed during the first 4 hours after delivery in all the neonates and then as clinically indicated in the case of ventilated patients. A lung ultrasound was performed in all the ventilated patients before extubation. 12 of the 25 ventilated patients were also monitored by aEEG. The decisions regarding the intubation and mechanical ventilation and the moment of extubation of the patients were taken by the clinicians in accordance with the local and international guidelines. The extubation failure was defined as the need to re-intubate the patient in the first 24 hours after the extubation. The lung ultrasound pattern was considered as normal if the image was consisting of A lines with rare B lines or ”double lung point” as in the case of the delayed absorption of fetal lung fluid and abnormal in the case of “white lung” appearance (coalescent B lines) or an image of consolidation. A normal aEEG was defined as the presence of a continuous normal voltage pattern with sleep-wake cycles present and an abnormal aEEG as either discontinuous normal voltage, burst-suppression, low voltage or flat background patterns. The lung ultrasound patterns in the first hours of life were compared between patients that needed intubation and those that did not need mechanical ventilation. The lung ultrasound and aEEG patterns before extubation were compared between the patients that did not need re-intubation and those with extubation failure. Results. An abnormal image on lung ultrasound was significantly associated with the risk of intubation (p &lt; 0.001) (sensitivity 84%, specificity 100%, positive predictive value 100% and negative predictive value 86.2%) An abnormal lung ultrasound pattern before extubation was associated with a significant risk of extubation failure (p &lt; 0.049) (sensitivity 75%, specificity 85%, positive predictive value 50%, negative predictive value 94.7%). In the case of the subset of patients in which aEEG was performed, an abnormal aEEG pattern was significantly associated with extubation failure (p &lt; 0.034) (sensitivity 100%, specificity 88%, positive predictive value 75%, negative predictive value 100%). In the case of association of the two parameters (lung ultrasound and aEEG pattern) there was again a statistically significant association between the abnormal patterns and extubation failure. Conclusions. An abnormal lung ultrasound during the first hours of life is a strong predictor for the need of intubation and mechanical ventilation in the neonates with respiratory distress. The normal lung ultrasound pattern just before extubation is predictive of a good evolution without the need for re-intubation of the patient. A normal aEEG pattern at the same time is associated also with a decreased risk of extubation failure.

Methylene Blue for the Treatment of COVID-19 in Pediatrics

Letter to the Editor Despite vaccination against SARS-CoV-2, the COVID-19 pandemic continues to expand worldwide. Early reports suggested that only a minor proportion of pediatric population is affected by COVID-19 in comparison to adult population. Three percent of pediatric population needed admission to intensive care units, and only a small number of deaths have been reported. Available literature suggests that infants (children under 1 year) seem to be more vulnerable to COVID-19 virus infection with a higher severity of illness compared with other pediatric ages. Requirement for neonatal mechanical ventilation is 20%–22.4% (vs. 4% in children). (1)

When synchronized isn't synchronous- an experimental benchmarking study on the efficiency of SIMV in very-low-birth weight premature infants.

Synchronized ventilation promotes a patient's ability to breathe spontaneously by providing intermittent, mechanical-controlled respiration that is synchronized with the patient's own efforts. In "synchronized-intermittent-mandatory-ventilation" SIMV, assisted ventilation is regulated by frequency settings which dictate the interval at which the ventilator becomes sensitive to respiratory efforts and responds with an assisted breath. SIMV has become one of the most widely used modes of ventilation in neonates. Using a neonatal-active-lung-model (NALM), this in-vitro benchmark study investigated how well synchronization works in SIMV with several ventilators. The competence of eight ventilators was tested using a NALM simulator representing a preterm infant weighing approximately 1500 grams. Two conditions were explored: first, the ventilators were set to a constant ventilation rate, while the NALM was adjusted to frequencies equal to and below this ventilation rate. The second condition varied the ventilators' rates while the NALM frequency was held constant. Correctly triggered breaths were counted and displayed as a percentage (%) of the total potential triggerable breaths. Performance among devices significantly differed, ranging from a low 38.9% competency to a max of 71.7% under the first condition, and 70.7% to 100% under the second condition. At high SIMV frequencies, synchronization between the patient and ventilator becomes increasingly limited. Despite their identical ventilator functions, SIMV algorithms of the various manufacturers and models tested, deliver ventilation rates with significantly different degrees of synchronization; not only in comparison to each other, but also in their own ability to continuously and effectively synchronize breaths under variable conditions, typical of preterm lungs.

Novel Neonatal Simulator Provides High-Fidelity Ventilation Training Comparable to Real-Life Newborn Ventilation.

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.

Lung Ultrasonography as Tool for Follow Up of Ventilated Neonates for Prediction of Weaning Readiness

Abstract Background Timing is crucial when deciding if a patient can be successfully extubated. Both premature discontinuation and unnecessary delay of mechanical ventilation weaning have been associated with poor outcome. There are no enough guidelines for the assessment of readiness of newborns for extubation. The degree of lung aeration loss in different clinical conditions can be quantified via lung ultrasound (LUS). Objectives To evaluate the lung ultrasound score as a follow up tool in ventilated neonates and its validity as predictor of extubation. Subjects and Methods Prospective study done on 39 mechanically ventilated neonates 27-42 weeks’ gestation. Lung ultrasound was done daily for each patient till the day of weaning and lung ultrasound (LUS) score was calculated. Patients were divided into 2 groups according to trial of weaning; Success “S” group: in which weaning succeeded and Failure “F” group: in which weaning failed. Results The “F” group had significantly higher LUS score at time of intubation, pre- extubation and post-extubation compared with the “S” group (P- value= 0.002, 0.003 and 0.001 respectively). A cut off value of ≤ 10 for LUS score pre-extubation predict successful weaning with sensitivity 76% and specificity 64.3%. Conclusion LUS is an indicator for lung aeration and can be used as a tool to predict success of weaning of ventilated neonates.

Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P &amp;gt; 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

Clinical characteristics and outcomes of neonates with polymicrobial ventilator-associated pneumonia in the intensive care unit

BackgroundVentilator associated pneumonia (VAP) caused by more than one microorganisms is not uncommon and may be potentially challenging, but the relevant data is scarce in ventilated neonates. We aimed to investigate the clinical characteristics and outcomes of polymicrobial VAP in the neonatal intensive care unit (NICU).MethodsAll neonates with definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and September 2020 were prospectively observed and enrolled for analyses. All clinical features, therapeutic interventions and outcomes were compared between the polymicrobial VAP and monomicrobial VAP episodes. Multivariate regression analyses were used to find the independent risk factors for treatment failure.ResultsAmong 236 episodes of neonatal VAP, 60 (25.4%) were caused by more than one microorganisms. Polymicrobial VAP episodes were more likely to be associated with multidrug-resistant pathogens (53.3% versus 34.7%, P = 0.014), more often occurred in later days of life and in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. Otherwise most clinical characteristics of polymicrobial VAP were similar to those of monomicrobial VAP. The therapeutic responses and treatment outcomes were also comparable between these two groups, although modification of therapeutic antibiotics were significantly more common in polymicrobial VAP episodes than monomicrobial VAP episodes (63.3% versus 46.2%; P < 0.001). None of any specific pathogens was significantly associated with worse outcomes. Instead, it is the severity of illness, including presence of concurrent bacteremia, septic shock, and requirement of high-frequency oscillatory ventilator and underlying neurological sequelae that are independently associated with treatment failure.ConclusionsPolymicrobial VAP accounted for 25.4% of all neonatal VAP in the NICU, and frequently occurred in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. In our cohort, most clinical features, therapeutic responses and final outcomes of neonates with monomicrobial and polymicrobial VAP did not differ significantly.