Ventilated Newborns Research Articles

Outcomes of postnatal systemic corticosteroids administration in ventilated preterm newborns: a systematic review of randomized controlled trials.

Prolonged mechanical ventilation, commonly used to assist preterm newborns, increases the risk of developing bronchopulmonary dysplasia (BPD). In recent decades, studies have demonstrated that systemic corticosteroids play a significant role in the prevention and management of BPD. In this systematic review of randomized controlled trials (RCTs), we evaluated the association between the administration of systemic corticosteroids in preterm infants and its long-term outcomes, such as neurodevelopment, growth, extubation rate, and related adverse effects. We conducted an electronic search in Medline, Scopus, and PubMed using the following terms: "premature infants" and "corticosteroids." We considered all RCTs published up to June 2023 as eligible. We included all studies involving preterm newborns treated with systemic corticosteroids and excluded studies on inhaled corticosteroids. A total of 39 RCTs were evaluated. The influence of steroids administered systemically during the neonatal period on long-term neurological outcomes remains unknown, with no influence observed for long-term growth. The postnatal administration of systemic corticosteroids has been found to reduce the timing of extubation and improve respiratory outcomes. Dexamethasone appears to be more effective than hydrocortisone, despite causing a higher rate of systemic hypertension and hyperglycemia. However, in the majority of RCTs analyzed, there were no differences in the adverse effects related to postnatal corticosteroid administration. Dexamethasone administered during the neonatal period appears to be more effective than hydrocortisone in terms of respiratory outcomes; however, caution should be taken when administering dexamethasone. Data derived from current evidence, including meta-analyses, are inconclusive on the long-term effects of the administration of systemic steroids in preterm infants or the possibility of neurodevelopmental consequences.

Real-Time Digital Feedback Device and Simulated Newborn Ventilation Quality.

Effective bag-valve-mask ventilation is critical for reducing perinatal asphyxia-related neonatal deaths; however, providers often fail to achieve and maintain effective ventilation. The Augmented Infant Resuscitator (AIR) attaches to bag-valve-masks and provides visual feedback on air leaks, blocked airways, harsh breaths, and improper ventilatory rates. We evaluated the effect of this real-time-digital feedback on ventilation quality and the effective determination of airway integrity in a randomized controlled study in Uganda and the United States. Birth attendants trained in newborn resuscitation were randomized to receive either real-time AIR device feedback (intervention) or no feedback (control) during ventilation exercises. Intervention-arm participants received a 2-minute orientation on interpreting AIR feedback using a single-page iconography chart. All participants were randomly assigned to 3 blinded ventilation scenarios on identical-appearing manikins with airways that were either normal, significantly leaking air, or obstructed. We enrolled 270 birth attendants: 77.8% from Uganda and 22.2% from the United States. Birth attendants receiving AIR feedback achieved effective ventilation 2.0 times faster: intervention mean 13.8s (95% confidence interval 10.6-17.1) versus 27.9s (21.6-34.3) for controls (P < .001). The duration of effective ventilation was 1.5 times longer: intervention mean 72.1s (66.7-77.5) versus 47.9s (41.6-54.2) for controls (P < .001). AIR feedback was associated with significantly more accurate and faster airway condition assessment (intervention mean 43.7s [40.5-47.0] versus 55.6s [51.6-59.6]). Providers receiving real-time-digital AIR device feedback achieved effective ventilation significantly faster, maintained it longer, and determined airway condition faster and more accurately than providers in the control group.

Protocol of randomized controlled trial comparing T piece resuscitator versus self-inflating bag for resuscitation in the delivery room in preterm neonates

Background: Neonatal resuscitation is a critical process for a newborn with effective ventilation as its key component. Three manual ventilation devices, including self-inflating bags (SIB), flow-inflating bags (FIB), and T-piece resuscitator (TPR) are recommended for positive pressure ventilation (PPV) in the delivery room. To date, there is insufficient evidence regarding the optimal device for establishing effective ventilation in newborns. This study is planned to compare the effectiveness of TPR and SIB during resuscitation. Methods: This will be a single centre, open-label, randomized controlled trial. Study participants will be preterm ≤34 of gestation needing PPV at birth as per NRP algorithm. Newborns will be randomly assigned to two groups (TPR or SIB). SpO2 at 2 and 5 min, time to reach heart rate &gt;100/min by pulse oximetry, and duration of PPV will be recorded. Primary outcome is need of delivery room intubation. Intention to treat analysis will be done using STATA version 17.0. A priori defined subgroup for purpose of analysis will be gestation ≤30 and 31-34 weeks. Trial will be done as per good clinical practice guidelines. Conclusions: If PPV with TPR is proven to be more efficacious in terms of less delivery room intubation, there would be a way towards finalizing the TPR as primary device for providing PPV during delivery room resuscitation at birth. This study has potential to bring down need of delivery room intubation with less duration of mechanical ventilation and morbidity in form of IVH, BPD and composite outcome of BPD and death. Trial registration: CTRI number: CTRI/2023/01/048660.

Prevalence of Snoring in Pregnancy and Its Maternal-Fetal Outcomes at Vajira Hospital

Background: Snoring is an important symptom that is associated with obstructive sleep apnea and increases the risk of adverse pregnancy outcomes. In Thailand, the prevalence of snoring during pregnancy is uncertain. Determining the prevalence and characteristics may reduce the prevalence of snoring and improve pregnancy outcomes. Objective: The primary outcome was to determine the prevalence of snoring in Thai pregnant women in the third trimester, including pregnancy and chronic onset. The secondary outcome was to investigate the associations between pregnancy outcome and habitual snorer or those identified as high risk by the Thai Berlin Questionnaire. Materials and Methods: Three hundred eighty-two singleton pregnant women aged at least 18 years and at least 33 weeks of gestational age were recruited from the antenatal care clinic at Vajira Hospital, Navamindradhiraj University, between November 2021 and September 2022 and filled out the Thai Berlin Questionnaire. The 382 pregnant women were identified the presence of snoring or high risk of OSA in the previous month. Medical records, including demographic information and pregnancy outcomes, were collected, and analyzed. Results: The prevalence of snoring was 31.4% in the third trimester of pregnancy of which 27% were pregnancy onset snoring and 4.4% were chronic onset snoring. Habitual snoring was significantly different from non-snoring in regard to the requirement for positive-pressure ventilation in newborns (aOR 6.67, 95% CI 1.2 to 35.54). The high risk group had significantly more pregnancy induced hypertension than the low risk group (aOR 5.96, 95% CI 2.15 to 16.5), gestational hypertension (aOR 13.6, 95% CI 2.1 to 86.8), preeclampsia (aOR 4.07, 95% CI 1.09 to 15.2), severe preeclampsia (aOR 4.9, 95% CI 1.15 to 20.93), preterm birth (aOR 6.21, 95% CI 1.58 to 24.42), and low birth weight of newborn (aOR 6.09, 95% CI 2.5 to 14.87). Conclusion: The prevalence of snoring among Thai pregnant women was comparable to previous Western studies. Screening pregnant women at risk of the symptom may provide an early chance to lower the prevalence of snoring and adverse pregnancy outcomes. Keywords: Snoring; Snoring in pregnancy; Pregnancy outcomes

Respiratory support settings as indicator of the transportability of newborns

Purpose. To evaluate the predictive value of the parameters of respiratory support for newborn patients with respiratory insufficiency in assessing non-transportability.Materials and methods. The observational, cohort, retrospective study included data from 284 trips of the transport team to ventilated newborns from August 1, 2017 to December 31, 2018, a subgroup of transportable patients (n=244) and newborns recognized as untransportable due to the presence of respiratory insufficiency (n=40) was identified. The assessment and comparison of anamnesis, the status at the time of arrival of the transport team, intensive care, the parameters of respiratory support and its correction, monitored parameters, as well as assessments on scales — KSHONN, NTISS and TRIPS.Results. Тhe calculated respiratory parameters have a high predictive value for the non-transportability of newborns: the AUC ROC for the mean airway pressure is 0.858 [0.785–0.931], for the saturation index of oxygenation — 0.931 [0.893–0.970], for the SpO2/FiO2 ratio — 0.937 [0.901–0.973]. These indicators demonstrate significantly higher values of AUC ROC in comparison with the KSHONN scales (AUC=0.812 (0.742–0.882)), NTISS (AUC=0.848 (0.793–0.904)), TRIPS (AUC=0.802 (0.726–0.879)) scales. The high predictor value of the mean airway pressure and the saturation index of oxygenation for nontransportability remains high regardless of the need for catecholamine infusion.Conclusion. Mean airway pressure, saturation oxygenation index and SpO2/FiO2 ratio demonstrate a high predictive value for the patient’s non-transportability, exceeding the accuracy of the scales (KSHONN, NTISS, TRIPS).

Neurally adjusted ventilatory assist in infants: A review article.

Neurally adjusted ventilatory assist (NAVA) and non-invasive (NIV)-NAVA are innovative modes of synchronized and proportional respiratory support. They can synchronize with the patients' breathing and promote patient comfort. Both techniques are increasingly being used these years, however experience with their use in newborns and premature infants in Taiwan is relatively few. Because increasing evidence supports the use of NAVA and NIV-NAVA in newborns and premature infants requiring respiratory assist to achieve better synchrony, the aim of this article is to discuss whether NAVA can provide better synchronization and comfort for ventilated newborns and premature babies. In a review of recent literature, we found that NAVA and NIV-NAVA appear to be superior to conventional invasive and non-invasive ventilation. Nevertheless, some of the benefits are controversial. For example, treatment failure in premature infants is common due to insufficient triggering of electrical activity of the diaphragm (EAdi) and frequent apnea, highlighting the differences between premature infants and adults in settings and titration. Further, we suggest how to adjust the settings of NAVA and NIV-NAVA in premature infants to reduce clinical adverse events and extubation failure. In addition to assist in the use of NAVA, EAdi can also serve as a continuous and real-time monitor of vital signs, assisting physicians in the administration of sedatives, evaluation of successful extubation, and as a reference for the patient's respiratory condition during special procedures.

Evaluation of deadspace effects created by heat and moisture exchange filter during artificial lung ventilation in newborns

Heat and moisture exchange filters create additional dead space, comparable in volume to physiological, in premature newborns. It makes carbon dioxide remove difficultу. Reducing the dead space volume by increasing the flow in the ventilator circuit can lead to the hypocapnia. Aim of the study was to determine the safety and efficiency of gas flow boost in the ventilator circuit to hypercapnia compensation created by the additional dead space. Material and methods. The effect of the additional dead space created by a heat and moisture exchange filter on hemoglobin saturation and partial pressure of carbon dioxide at the end of expiration in premature newborns at flows of 5 and 6 l/min was studied. Results and discussion. It has been demonstrated that flows of 5–6 l/min satisfactorily compensate for the effect of additional deadspace without hypocapnia. Conclusions. It is possible to recommend the widespread use of heat and moisture exchange filters in newborn weighing at least 1.0 kg during long-term transportation.

ИСКУССТВЕННАЯ ВЕНТИЛЯЦИЯ ЛЕГКИХ С ЦЕЛЕВЫМ ДЫХАТЕЛЬНЫМ ОБЪЕМОМ У НОВОРОЖДЕННЫХ И ДЕТЕЙ РАННЕГО ВОЗРАСТА С РАЗЛИЧНЫМИ ЗАБОЛЕВАНИЯМИ ЛЕГКИХ: ПРОТОКОЛ ПОДГОТОВКИ ДЫХАТЕЛЬНОГО АППАРАТА И УПРАВЛЕНИЯ ПАРАМЕТРАМИ ВЕНТИЛЯЦИИ

One of the leading trends in modern medicine is the principle of prevention, which consists in preventing the formation of diseases and complications of therapy. The main damaging factor during respiratory support in patients with inhomogeneous lung tissue injury is tidal volume (TV). With traditional pressure controlled mechanical ventilation (PCMV), controlling the TV delivered to the child is difficult due to the variable mechanical properties of the lung tissue. PCMV algorithms with targeted TV, used in neonatology and in young children, make it possible to adjust the parameters of endotracheal respiratory support automatically. Thus, the principle of prevention is observed from inspiration to inspiration, and TV values become more constant, despite the changing respiratory mechanics. This protects the lungs from volumotrauma and ensures favorable outcomes. The purpose of this work is to review the existing recommendations on the use of dual-control modes of ventilation in newborns and young children and to present a protocol for preparing the breathing apparatus and controlling parameters when using PCMV with guaranteed TV.

ВЛИЯНИЕ ГЕСТАЦИОННОГО ВОЗРАСТА НОВОРОЖДЕННЫХ НА ТЕЧЕНИЕ НЕОНАТАЛЬНОГО ПЕРИОДА ПРИ АНОМАЛИЯХ ИНВАЗИИ ПЛАЦЕНТЫ

Objective of the study: to determine the timing of optimal delivery and to identify the features of the course of the neonatal period in children from mothers with placental accreta. Materials and methods of research: the analysis of medical records of 140 children of mothers with placental accreta (main group) and 60 newborns of mothers without placental accreta (comparison group) of various gestational ages (GA), born in the period of 2014–2020, was carried out. The paper presents the results of a single-center retrospective non-randomized continuous comparative study. Results: the effect of GA on the length of the newborn's stay in the neonatal intensive care and intensive care units (ICU) and the hospital as a whole was confirmed. The dependence of the need for respiratory support in newborns on the gestational age was confirmed: with a decrease in GA, the need for respiratory support in newborns increases statistically significantly (p=0.0011), the need for traditional mechanical ventilation in newborns increases statistically significantly (p&lt;0.001). When analyzing the frequency of occurrence of asphyxia, no statistically significant differences were found in the main group and in the comparison group. There were no statistically significant differences (p=0.229) in the body weight of newborns developing during pregnancy complicated by placenta previa compared with newborns born to mothers without a placental invasion anomalies. As a result of our study, there were no statistically significant differences in the length of stay in ICU and hospital for newborns of the same GA of the main group and the comparison group.

Automation of Non-invasive Artificial Ventilation for Newborns Based on the Processing of Pressure Signals and Oxygen Concentration in the Gas-air mixture

The article is devoted to the development of a control system for the respiratory circuit of an artificial lung ventilation (ALV) device to support the alveolar mobilization maneuver of premature newborns. Since in modern ALVs their adjustment for the maneuver of recruitment of lungs of premature newborns is carried out manually by adjusting the mechanical valve, the creation of a respiratory circuit control system will significantly reduce the time of adjustment and reduce the number of errors that occur during its implementation. The paper proposes the architecture of the respiratory circuit control system of the ALV, which consists of two control loops: one for regulating the pressure of the respiratory mixture, the second for regulating the oxygen concentration in the respiratory mixture. A simplified model of the breathing circuit control system, developed in the MATLAB Simulink dynamic simulation environment, makes it possible to evaluate the performance of this architecture. CHR method and manual tuning method based on knowledge of the system operation are used to search for the coefficients of the controllers of the control system. The Nyquist criterion is used to assess the stability of the system model. The application of the Nyquist criterion makes it possible to conclude that the breathing circuit control system is stable. A testing device of the control circuit has been developed and tested to assess the performance of the respiratory circuit control system. The conclusion has been made about the adequacy of the developed model and the operability of the proposed technical solution on the basis of testing.

Outcome, Clinical Profile and Risk Factors for Mortality of Neonates Necessitating Mechanical Ventilation

Background: Assisted ventilation has turn out to be an essential part of the neonatal intensive care unit (NICU). It is one of the main methods of support in the ICU and undoubtedly influences the survival of sick newborns. Aims: 1. To investigate common indications for mechanical ventilation in newborns 2. To investigate factors influencing the outcome. Method: It is a descriptive study of 60 infants admitted to the Department of Pediatric Medicine in the ICU over a one-year period in the department of Paediatrics, Abbasi Shaheed Hospital. The information was gathered and analysed in a pre-designed format. Results: Of a total of 60 infants, 46 survived, 14 died, and one infant was discharged despite medical advice. 36 children were born vaginally, 20 were born via LSCS, and 4 via assisted delivery. Postnatal asphyxia was the most common ventilation indication in full-term newborns, while HMD was present in preterm infants. The best results were obtained in ventilated infants with MAS, with 100% survival, followed by apnoea in premature infants, perinatal asphyxia, and HMD. Pulmonary haemorrhage (48.3%) was the most common complication among deceased infants, followed by sepsis (28.3%) and shock (23.4%) with a significant p &lt;0.05. There were no complications in 76.7% of the surviving infants. Conclusions: Among the many widely available variables studied in this study, maximum and mean peak inspiratory pressure (PIP or (PEEP), maximum respiratory rate, maximum mean airway pressure (MAP) and average ventilation demand was much greater among non-survivals in comparison to the survivors. Bicarbonate, PH and excess base have been found to be important determinants of mortality in ventilated newborns. Keywords: Indications, mechanical ventilation and Results

A Randomised Controlled Study of Low-Dose High-Frequency In-Situ Simulation Training to Improve Newborn Resuscitation.

Positive pressure ventilation of the non-breathing newborn is a critical and time-sensitive intervention, considered to be the cornerstone of resuscitation. Many healthcare providers working in delivery units in high-resource settings have little opportunity to practise this skill in real life, affecting their performance when called upon to resuscitate a newborn. Low-dose, high-frequency simulation training has shown promise in low-resource settings, improving ventilation performance and changing practice in the clinical situation. We performed a randomised controlled study of low-dose, high-frequency simulation training for maintenance of ventilation competence in a multidisciplinary staff in a busy teaching hospital in Norway. We hypothesised that participants training according to a low-dose, high-frequency protocol would perform better than those training as they wished. Our results did not support this, although the majority of protocol participants were unable to achieve training targets. Subgroup analysis comparing no training to at least monthly training did identify a clear benefit to regular simulation practice. Simulated ventilation competence improved significantly for all participants over the course of the study. We conclude that frequent, short, simulation-based training can foster and maintain newborn ventilation skills in a multidisciplinary delivery unit staff in a high-resource setting.

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.

Post-mortem computed tomography is a useful tool for determining the pulmonary ventilation status in newborns

Abstract Introduction Lung ventilation is a standard sign of life in newborns. Post-mortem computed tomography (PMCT) is highly sensitive to the presence of gas in the body including the lungs. Current standard examinations to determine the pulmonary ventilation status in newborns are the flotation test and histology. The purpose of this study was to compare the accuracy of PMCT with the flotation test for determining the lung ventilation status with histological control as reference standard. A cut-off value as CT number in Hounsfield Units (HU) determining lung ventilation of newborns in PMCT should be established. Methods A total of 38 infant lungs were examined of which 21 lungs were from infants deceased shortly after live birth (control group) and 17 lungs belonged to infants where live birth was in question (study group). All lungs were examined using PMCT, flotation test, and histological examination. Results The control group showed an overall mean attenuation ± standard deviation of −219 HU ± 135; the study group of 45 ± 15 HU in histologically nonventilated lungs versus −192 ± 207 HU; (p &lt; 0.001) in ventilated lungs. The best cut-off value for optimal discrimination of ventilated and nonventilated lungs in newborns was −35 mean HU. Conclusion PMCT is equally well suited to determine lung ventilation as the flotation test. It provides additional information regarding pulmonary infiltration, degree of putrefaction, or signs of trauma (fractures, pneumothorax). Histology remains mandatory in ambiguous cases.

Potential benefits of melatonin to control pain in ventilated preterm newborns: An updated review.

Infants admitted to neonatal intensive care units are repeatedly stimulated by painful events, especially if intubated. Preterm infants are known to have greater pain perception than full term infants due to immaturity of descending inhibitory circuits and poor noxious inhibitory modulation. Newborns exposed to repetitive painful stimuli are at high risk of impairments in brain development and cognition. Chronic pain is induced and supported by proinflammatory cytokines, free radicals, and reactive oxygen species creating a self‐ sustaining vicious circle. Melatonin is a neurohormone secreted by the pineal gland with antioxidant and anti‐inflammatory functions. This review describes the in‐depth beneficial effects of melatonin for pain control in ventilated preterm newborns. As yet, a minimal amount of literature has been undertaken to consider all its promising bioactivities. The rationale behind the use of melatonin for pain control has also been taken into account in this review. Besides, this review addresses safety concerns and dosages. The potential benefits of melatonin have been assessed against neurological disorders, respiratory distress, microbial infections, and as analgesic adjuvant during ventilation. Additionally, a possible approach for the use of melatonin in ventilated newborns will be discussed.

Expired carbon dioxide during newborn resuscitation as predictor of outcome

AimTo explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome. MethodsObservational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0–30 s, 30.1–60 s and 60.1–300 s). ResultsAmong 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO2 added extra predictive information compared to HR alone. After 60 s, ECO2 lost significance when adjusted for HR. In 70% of newborns with initial ECO2 <2% and HR < 100 bpm, ECO2 reached ≥2% before HR ≥ 100 bpm. Survival at 24 h was reduced by 17% per minute before ECO2 reached ≥2% and 44% per minute before HR reached ≥100 bpm. ConclusionsHigher levels and a faster rise in ECO2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO2 increased before HR and may serve as an earlier predictor of survival.

Mechanical Ventilation, Partial Pressure of Carbon Dioxide, Increased Fraction of Inspired Oxygen and the Increased Risk for Adverse Short-Term Outcomes in Cooled Asphyxiated Newborns

Neonates treated with therapeutic hypothermia (TH) following perinatal asphyxia (PA) suffer a considerable rate of disability and mortality. Several risk factors associated with adverse outcomes have been identified. Mechanical ventilation might increase the risk for hyperoxia and hypocapnia in cooled newborns. We carried out a retrospective study in 71 asphyxiated cooled newborns. We analyzed the association of ventilation status and adverse short-term outcomes and investigated the effect of the former on pCO2 and oxygen delivery before, during and after TH. Death, abnormal findings on magnetic resonance imaging, and pathological amplitude-integrated electroencephalography traces were used to define short-term outcomes. The need for mechanical ventilation was significantly higher in the newborns with adverse outcomes (38% vs. 5.6%, p = 0.001). Compared to spontaneously breathing neonates, intubated newborns suffered from significantly more severe asphyxia, had significantly lower levels of mean minimum pCO2 over the first 6 and 72 h of life (HOL) (p = 0.03 and p = 0.01, respectively) and increased supply of inspired oxygen, which was, in turn, significantly higher in the newborns with adverse outcomes (p < 0.01). Intubated newborns with adverse short-term outcomes had lower levels of pCO2 over the first 36 HOL. In conclusion, need for mechanical ventilation was significantly higher in newborns with more severe asphyxia. In ventilated newborns, level of encephalopathy, lower pCO2 levels, and increased oxygen supplementation were significantly higher in the adverse short-term outcomes group. Ventilatory parameters need to be carefully monitored in cooled asphyxiated newborns.

1019 Twin gestations conceived via in vitro fertilization are associated with increased adverse pregnancy outcomes

We aimed to determine whether conception via in vitro fertilization (IVF) is associated with an increased risk of adverse pregnancy, and neonatal outcomes in twin gestations. Retrospective analysis of the Centers for Disease Control and Prevention, Natality Live Birth database (2016-2018). All twin gestations were included and stratified into two groups: those conceived via IVF and those conceived spontaneously. The incidence of several adverse pregnancy and neonatal outcomes were compared between the two groups. Statistical analysis included Chi-squared test with Bonferroni adjustment, as well as multivariate logistic regression adjusting for potential confounders such as maternal age, race/ethnicity, body mass index (BMI), chronic hypertension, pregestational diabetes, and prior preterm birth. Data were presented as adjusted Odds Ratios (aOR) with 95% confidence intervals (CI). Statistical significance was defined as P value < 0.05. IVF twin births comprised 9% of the study cohort (32,100 of 338,409). Baseline characteristics such as maternal age, BMI, race/ethnicity, pre-gestational diabetes and smoking varied significantly between groups (Table 1). After adjusting for these variables, IVF in twins was associated with an increased risk of multiple adverse outcomes such as hypertensive disorders of pregnancy (aOR 1.72, 95% CI 1.67-1.79), maternal blood transfusion (aOR 2.67, 95% CI 2.46-2.90), unplanned hysterectomy (aOR 3.27, 95% CI 2.62-4.09), and prolonged ventilation in newborns (aOR 1.69, 95% CI 1.62-1.76), compared to spontaneously conceived twin gestations (Table 2). Based on this large US population-based cohort, twin gestations conceived via IVF are at increased risk for several adverse pregnancy and neonatal outcomes, compared to those conceived spontaneously. With increased utilization of IVF techniques, obstetricians should consider these risks while caring for patients with twin gestations conceived via IVF.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The effectiveness of volume guarantee ventilation in newborns

Background. An important goal of treating respiratory disorders in newborns during the first stage of perinatal care is effective and safe pulmonary ventilation, enabling the administration of surfactant therapy, reducing alveolar dead space, and providing adequate gas exchange.&#x0D; Objective. The aim of this study is to improve the quality of newborns respiratory therapy using double pressure and volume control at the first stage of perinatal care.&#x0D; Materials and methods. The study involved newborns from week 27 to week 42 gestation with respiratory failure requiring invasive pulmonary ventilation. The ventilation mode was evaluated with pressure control and volume guarantee option compared with routine pressure ventilation. For the comparative characteristic of the compared ventilation methods, we used targets, such as the duration of artificial pulmonary ventilation, reduction of FiO2, dynamics of venous blood lactate, peak and average pressure in the respiratory tract, dynamics of lung compliance, and the development of complications.&#x0D; Results and conclusions. Given the heterogeneity of lung damage in newborns, the use of the guaranteed volume option reduced the duration of mechanical ventilation, the development frequency of IVH, and the frequency of surfactant use.

Efficacy and safety of volume guarantee ventilation in newborns with birth weight less than 750 grams in the delivery room

Efficacy and safety of volume guarantee ventilation in newborns with birth weight less than 750 grams in the delivery room