phenylephrine-hydrochloride and Infant--Premature--Diseases

Continuous positive airway pressure (CPAP), noninvasive intermittent positive pressure ventilation (NIPPV), and heated humidified high-flow nasal cannula (HHFNC) are modes of noninvasive respiratory support used in neonatal practice. These modes of noninvasive respiratory support may obviate mechanical ventilation, prevent extubation failure, and reduce the risk of developing bronchopulmonary dysplasia. Although the physiologic bases of CPAP and HHFNC are well delineated, and their modes and practical application consistent, those of NIPPV are unproven and varied. Available evidence suggests that NIPPV is superior to CPAP as a primary and postextubation respiratory support in preterm infants.

Topics: Continuous Positive Airway Pressure; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intermittent Positive-Pressure Ventilation; Nose; Respiration, Artificial

Nasal high-flow therapy (nHF) is increasingly used for neonates, with perceived benefits including reduced rates of nasal trauma and parent and nursing staff preference. Current evidence suggests that although nHF is a reasonable alternative for postextubation support of preterm infants, continuous positive airway pressure is a superior modality for primary support of respiratory distress syndrome. Minimal evidence exists for use of nHF in extremely preterm infants less than 28 weeks' gestation. Depending on clinician preference, units may still choose nHF in some settings, although careful choice of appropriate patients, and availability of rescue continuous positive airway pressure, is essential.

Topics: Continuous Positive Airway Pressure; Gestational Age; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases; Nose; Oxygen Inhalation Therapy

Respiratory failure in the premature infants remains a difficult challenge. An alternative to the use of nasal continuous positive airway pressure (NCPAP) as a non-invasive modality to support respiratory distress in premature infants has been the recent introduction of high flow nasal cannula (HFNC) devices in many neonatal units. There has been increased use of HFNC presumably because of anecdotal reports and experience that it is easy to use, and well tolerated by the infants, while experiencing decreased nasal septumerosion. The paucity of evidence regarding its efficacy and safety, would support a caution approach to the use of HFNC. Particular concern has focused on the imprecise regulation and generation of pressure that may occur at higher flows especially in the smallest of infants.

Topics: Catheters; Continuous Positive Airway Pressure; Humans; Infant, Newborn; Infant, Premature, Diseases; Intubation; Noninvasive Ventilation; Nose; Respiratory Distress Syndrome, Newborn

This study examined the usefulness of nasal Duo positive airway pressure (DuoPAP) in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome (NRDS).. Eighty-five very low birth weight preterm infants with NRDS were randomly divided into two groups. Forty-five infants were treated with DuoPAP, while 40 infants were treated using nasal continuous positive airway pressure (nCPAP). The study outcomes were pH, PaCO, PaO₂, oxygenation index (PaO₂/FiO₂), and the number of failure cases at 1, 12, and 24 hours after non-invasive respiratory support.. At all studied time points, after non-invasive respiratory support, PaCO₂, PaO₂ and oxygenation index were significantly (p < 0.05) better in the nasal DuoPAP group compared with nasal CPAP group. In addition, rates of failure of assisted ventilation (respectively, 4.44% vs. 22.50%) and the occurrence of apnea (13.33% vs. 32.50%) were significantly (p < 0.05) better in the nasal DuoPAP group. Other parameters (such as duration of noninvasive ventilation, number of retinopathies of premature children, intraventricular hemorrhages, or periventricular leukomalacias) were comparable between both non-invasive regimen.. Nasal DuoPAP better improves oxygenation, reduces CO₂ retention, and diminishes the need for invasive mechanical ventilation and complications in the treatment of NRDS.

Topics: Blood Gas Analysis; Continuous Positive Airway Pressure; Female; Humans; Hypercapnia; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Nose; Respiratory Distress Syndrome, Newborn; Treatment Outcome

The objectives of this study were (1) to devise a nasal trauma score for preterm infants receiving non-invasive respiratory support, (2) to compare the incidence of nasal trauma in preterm infants <32 weeks gestation randomised to either nasal continuous positive airway pressure (NCPAP) or heated humidified high-Flow nasal cannulae (HHHFNC), in the first 7 days post-extubation and (3) to assess the effect of two different nasal dressings in those assigned to NCPAP. We randomly assigned preterm ventilated infants to receive Vapotherm® HHHFNC or NCPAP post-extubation. Infants receiving HHHFNC were treated with Sticky Whiskers® and infants receiving NCPAP received either Sticky Whiskers® or Cannualaide® nasal dressings. Bedside nursing staff scored six sites on each infant's nose for erythema, bleeding or ulceration. Scores were recorded three times daily for the first 7 days post-extubation. The sum of these 21 scores was used as the summary measure of nasal trauma. The mean nasal trauma score for infants assigned HHHFNC was 2.8 (SD 5.7) compared to 11.7 for NCPAP (SD 10.4), p < 0.001. There was no difference in mean trauma score between infants on NCPAP assigned Sticky Whiskers® 14.4 (SD 12.5) or Cannualaide® 9.5 (SD 7.3), p = 0.06.. HHHFNC resulted in significantly less nasal trauma in the first 7 days post-extubation than NCPAP and was most significant in infants <28 weeks of gestation. The use of protective dressings was not associated with decreased nasal trauma for infants on NCPAP.

Topics: Airway Extubation; Bandages; Catheters; Continuous Positive Airway Pressure; Epistaxis; Equipment Design; Erythema; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nose; Respiratory Insufficiency; Trauma Severity Indices; Ulcer

To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants.. Thirty-two premature infants receiving nasal CPAP for apnea or mild respiratory distress were enrolled. Birth weight was (mean +/- standard deviation) 1081 +/- 316 g, gestational age 29 +/- 2 weeks, age at study 13 +/- 12 days, and fraction of inspired oxygen (FIO(2)) at study.29 +/-.1. Three devices, applied in random order, were studied in each infant: continuous flow nasal CPAP via CPAP prongs, continuous flow nasal CPAP via modified nasal cannula, and variable flow nasal CPAP. After lung recruitment to standardize volume history, changes in lung volume (DeltaV(L)) were assessed at nasal CPAP of 8, 6, 4, and 0 cm H(2)O using calibrated direct current-coupled respiratory inductance plethysmography.. DeltaV(L) was significantly greater overall with the variable flow device compared with both the nasal cannula and CPAP prongs. However, DeltaV(L) was not different between the cannula and the prongs. Respiratory rate, tidal volume, thoraco-abdominal asynchrony, and FIO(2) were greater with the modified cannula than for either of the other 2 devices.. Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased respiratory effort and FIO(2).

Topics: Apnea; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lung Compliance; Nose; Positive-Pressure Respiration; Respiration; Respiratory Insufficiency; Total Lung Capacity

This trial assessed the consequences of discontinuation of nasal-CPAP in stable preterm infants breathing room air. Eighty-eight infants with a mean gestational age of 29 (24-33) weeks and a mean birthweight of 1264 (665-2060)g, randomized to either discontinuation of CPAP or its continuation, were clinically observed and monitored for 6 h by cardiorespiratory monitor, pulse oximeter and transcutaneous blood gas monitor. The abdominal circumference and gastric air and aspirate volumes were measured prior to meals at trial entry and after 6 h. Discontinuation of CPAP led to a small but significant decrease in oxygenation at 1 and 6 h. During the trial, five infants in the experimental group required supplemental oxygen and one infant was put back on CPAP owing to excessive apnoeas. Discontinuation of CPAP did not influence the TcPCO2 or the number of apnoeas and bradycardias during the trial, but led to significantly increased respiratory rate, retractions, and flaring at 6 h. It also led to a significant decrease in the abdominal circumference and gastric air volume. Thirty-nine percent of infants were put back on CPAP some time after the trial, mainly because of recurrent apnoeas and bradycardias. Taking the infant off CPAP during the trial reduced subsequent use of CPAP.

Topics: Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Monitoring, Physiologic; Nose; Positive-Pressure Respiration; Prospective Studies; Pulmonary Gas Exchange; Respiratory Distress Syndrome, Newborn; Respiratory Mechanics; Survival Rate; Treatment Outcome; Ventilator Weaning

The efficacy of nasal intermittent positive pressure ventilation (NIPPV) in treating apnea of prematurity was evaluated. Apneic preterm infants were randomly assigned to receive either NIPPV or continuous positive airway pressure (NCPAP) for 4 hr when they failed to respond to conservative therapy. The amount of reduction in apneic spells and bradycardia in the two groups after treatment was compared. Thirty-four infants (18 with NIPPV, 16 with NCPAP) were enrolled. Their birth weights ranged from 590-1,880 g (mean, 1,021 g) and gestational ages from 25-32 weeks (mean, 27.6 weeks). The baseline characteristics were comparable in the two groups. Frequency of apnea and bradycardia was reduced during both forms of treatments. However, the infants receiving NIPPV had a greater reduction of apneic spells (P = 0.02) and a tendency to greater decrease in bradycardia (P = 0.09) than those receiving NCPAP. We conclude that NIPPV is more effective than NCPAP in reducing apnea in preterm infants. NIPPV may reduce bradycardia; however, this needs to be validated by a larger number of observations.

Topics: Apnea; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intermittent Positive-Pressure Ventilation; Nose; Positive-Pressure Respiration; Statistics, Nonparametric

Nasal continuous positive airway pressure support (nCPAP) is the standard of care for prematurely born infants at risk of neonatal respiratory distress syndrome (nRDS). However, nasal intermittent positive pressure ventilation (NIPPV) may be an alternative to nCPAP in babies requiring surfactant, and in conjunction with surfactant nebulization, it could theoretically reduce the need for invasive mechanical ventilation. We compared lung deposition of nebulized poractant in newborn piglets supported by nCPAP or NIPPV.. Twenty-five sedated newborn piglets (1.2-2.2 kg) received either nCPAP (3 cmH. Mean surfactant deposition in the lungs was 15.9 ± 11.9% [8.3, 23.5] (mean ± SD [95% CI]) in the nCPAP group and 21.6 ± 10% [15.6, 27.6] in the NIPPV group (P = .20). Respiratory rates were similar in both groups. Minute volume was 489 ± 203 [360, 617] in the nCPAP group and 780 ± 239 [636, 924] mL kg. Irrespective of the noninvasive ventilatory support mode used, relatively high lung deposition rates of surfactant were achieved with nebulization. The amounts of deposited surfactant might suffice to elicit a pulmonary function improvement in the context of nRDS.

Topics: Animals; Animals, Newborn; Biological Products; Continuous Positive Airway Pressure; Infant, Premature; Infant, Premature, Diseases; Intermittent Positive-Pressure Ventilation; Lung; Nebulizers and Vaporizers; Nose; Phospholipids; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Surface-Active Agents; Swine

Topics: Continuous Positive Airway Pressure; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Necrosis; Nose; Pressure Ulcer; Treatment Outcome

We examined the relationship between the use of nasal continuous positive airway pressure (CPAP) and nasal colonization among low-birth-weight (LBW) infants. We prospectively cultured the nares of LBW infants on admission and weekly until hospital discharge. The modality of respiratory support during each culture was recorded. Bivariate and multivariate analyses were conducted to test the relationship between CPAP and nasal colonization. Analyses were repeated after stratifying infants into three birth-weight categories: 1500 to 2499 g, 1000 to 1499 g, and < 1000 g. In total, 766 nasal cultures were obtained from 167 infants. Nasal colonization with gram-negative bacilli was increased with the use of CPAP in all birth-weight categories ( P < 0.05) and with vaginal delivery in infants weighing < 1000 g and 1500 to 2499 g ( P = 0.04 and P = 0.02, respectively). Nasal colonization with any potential pathogen increased with the use of CPAP in all birth-weight categories ( P < 0.001), with the presence of chorioamnionitis in infants < 1000 g ( P = 0.055) and at younger gestational age in infants 1000 to 1499 g ( P = 0.0026). Caucasian infants 1500 to 2499 g had less colonization than infants of other races ( P = 0.01). Nasal CPAP is associated with increased colonization with gram-negative bacilli.

Topics: Bacteremia; Chorioamnionitis; Colony Count, Microbial; Continuous Positive Airway Pressure; Delivery, Obstetric; Female; Gestational Age; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Logistic Models; Male; Nose; Pregnancy; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Otorhinolaryngological examination makes it possible to objectively evaluate the state of ENT organs in prematurely born babies, take adequate measures to ensure their survival, undertake early prevention of ENT pathologies, carry out rehabilitation in case of post-resuscitation or congenital complications, and form groups of children selected for the follow-up and further treatment by an otorhinolaryngologist.

Topics: Ear; Early Diagnosis; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Nose; Otorhinolaryngologic Diseases; Pharynx

We conducted this study to assess the rate of methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in methicillin-resistant S aureus-endemic NICUs.. Between March 2003 and February 2004, surveillance culture specimens from the nares, postauricular areas, axillae, and umbilicus of infants admitted to the NICUs at a children's hospital in Taiwan were obtained weekly for the detection of methicillin-resistant S aureus. All colonized and clinical isolates from each study infant with methicillin-resistant S aureus infection were genotyped with pulsed-field gel electrophoresis, with Sma1 digestion, and compared.. A total of 783 infants were included in this study. Methicillin-resistant S aureus colonization was detected for 323 infants during their NICU stays, with detection with the first 2 samples for 89%. Nares and umbilicus were the 2 most common sites of initial colonization. Methicillin-resistant S aureus colonization was associated significantly with premature birth (< or = 28 weeks) and low birth weight (< or = 1500 g), and infants with colonization had a significantly higher rate of methicillin-resistant S aureus infection, compared with those without colonization (26% vs 2%). Methicillin-resistant S aureus colonization was noted for 84 of 92 infants with methicillin-resistant S aureus infections. Of the 68 episodes with previous colonization and isolates available for genotyping analysis, colonized and clinical isolates were indistinguishable in 63 episodes, highly related in 2 episodes, and distinct in 3 episodes.. More than 40% of the hospitalized infants were colonized with methicillin-resistant S aureus during their stay in methicillin-resistant S aureus-endemic NICUs; this was associated significantly with methicillin-resistant S aureus infection. Most infants with methicillin-resistant S aureus infections had previous colonization with an indistinguishable strain.

Topics: Axilla; Bacteremia; Bacterial Typing Techniques; Birth Weight; Carrier State; Cross Infection; DNA, Bacterial; Ear, External; Female; Gestational Age; Hospitals, Pediatric; Hospitals, University; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Male; Methicillin Resistance; Nose; Patient Isolation; Skin; Sputum; Staphylococcal Infections; Staphylococcus aureus; Taiwan; Umbilicus

Reports of methicillin-resistant Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICU) and normal newborn nurseries in Japan were investigated, and various methods of preventing transmission were evaluated. In the late 1980s, MRSA which had spread in adult wards also invaded NICU. Very low birthweight or premature infants had become the targets of MRSA infection and this has now become a serious problem. Recent reports have revealed that 87% of major NICU in Japan have suffered from MRSA infections. However, we have found that preventive measures can greatly reduce the risk of a newborn being infected by a carrier, while also controlling the disease caused by MRSA infection. Recently, MRSA infections in normal newborn nurseries have also become a serious problem in pediatric departments. Methicillin-resistant Staphylococcus aureus which can colonize in the newborn baby just after birth, is passed on to the newborn by carrier medical staff. It was found to be of great importance that infant's mothers hold and nurse their babies immediately after birth, and start breast-feeding while still in the delivery room. Furthermore, the most appropriate and ideal newborn nursery is one where mother and child are roomed together and there is little intervention by the hospital. In neonatal care, it is of utmost importance to treat carriers of MRSA bacteria, and to inhibit the spread of the bacterium in babies by taking standard precautionary measures.

Topics: Breast Feeding; Cross Infection; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Intubation, Intratracheal; Japan; Methicillin Resistance; Nose; Pharynx; Skin; Staphylococcal Infections

Topics: Apnea; Bradycardia; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Mouth; Nose; Suction

Topics: Conjunctiva; Ear Canal; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Nose; Pharynx; Risk; Umbilicus

Topics: Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nose

The frequency and duration of complications were compared in premature babies fed by nasojejunal and nasogastric tubes. Some factors may have weighted the results against the nasojejunal tube-fed group, but this study failed to demonstrate differences in the rate and duration of complications.

Topics: Diarrhea, Infantile; Enteral Nutrition; Humans; Infant, Newborn; Infant, Premature, Diseases; Nose; Stomach

Continuous nasojejunal drip is a common method of feeding low-birthweight neonates because it is relatively free of complications and provides nutritional requirements. We recently encountered a case of duodenal perforation caused by a feeding catheter. Recommendations are made that can prevent this complication in the future.

Topics: Birth Weight; Duodenal Diseases; Enteral Nutrition; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Perforation; Jejunum; Male; Nose; Radiography

Continuous positive airway pressure (CPAP) by means of a bilateral nasal cannula system has been used in 21 newborns. 15 had hyaline membrane disease, 3 had an aspiration and 3 showed extensive atelectasis. In 18 of the 21 patients, paO2 increased after cannulation, FiO2 being kept unaltered. As a consequence, the oxygen concentration in the inspired gas mixture could be lowered. 3 children had to be intubated endotracheally and ventilated artificially despite previous nasal cannulation. The criteria for using the CPAP and the methodology are described, its advantages, disadvantages and dangers discussed.

Topics: Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Inhalation; Methods; Nose; Oxygen; Partial Pressure; Positive-Pressure Respiration; Pressure; Pulmonary Alveoli; Pulmonary Atelectasis; Respiration; Respiratory Distress Syndrome, Newborn

Topics: Birth Weight; Catheterization; Humans; Infant, Newborn; Infant, Premature, Diseases; Intubation, Intratracheal; Nasal Septum; Nose; Polyvinyls; Positive-Pressure Respiration; Respiratory Distress Syndrome, Newborn; Silicone Elastomers

Topics: Birth Weight; Blood Urea Nitrogen; Body Weight; Calorimetry; Dietary Proteins; Enteral Nutrition; Gestational Age; Glucose; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Jejunum; Methods; Monitoring, Physiologic; Nose; Time Factors

Topics: Complement Fixation Tests; Cross Infection; Cytomegalovirus; Cytomegalovirus Infections; Feces; Female; Hemagglutination Tests; Humans; Immunoglobulins; Infant, Newborn; Infant, Premature, Diseases; Male; Nose; Nurseries, Hospital; Pharynx; Transfusion Reaction; Urine

Topics: Anal Canal; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Labor, Obstetric; Nose; Pregnancy

Topics: Adaptation, Biological; Birth Injuries; Brain Injuries; Extraembryonic Membranes; Female; Fetal Death; Fetus; Hearing Disorders; Humans; Infant, Newborn; Infant, Premature, Diseases; Labor, Obstetric; Nose; Otitis Media; Pregnancy; Respiration; Respiratory Distress Syndrome, Newborn; Respiratory Tract Infections

Topics: Antibiosis; Bacteriophage Typing; Cross Infection; Culture Media; Disease Outbreaks; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Nose; Nurseries, Infant; Penicillin G; Pharmacology; Staphylococcal Infections; Staphylococcus; Umbilical Cord