Abstractscorrect ETT, 2. Assess PTU as a recordable accurate tool to document ETT position prior to surfactant administration to improve the 'golden hour management'. Methods Single centre prospective study involving ELBW neonates < 1000 gm requiring intubation post-delivery. Two recordings per infant were done -one in delivery room and second when the infant reaches NICU. Accuracy of PTU (Micromaxx®) was compared with clinical assessments, colorimetric CO 2 detection and Chest X-ray ETT position. Single operator conduced examinations who was not part of the resuscitation team. Hospital Research and Ethics committee approval was obtained. Results Seventeen ELBW infants had PTU in labour delivery room (n=17) yielding 34 recordings. For 5 out of 17 (29.4%) infants significant improvement of ETT position could be offered by the use of PTU which otherwise was not detected. It is feasible to measure and record diaphragmatic excursion bilaterally during the labour ward resuscitation environment. The diagnostic accuracy of PTU for correct ETT was greater than that by traditional clinical methods and colorimetric CO 2 detection. Inter-operator consistency and value of hand-held device (VScan®) is being evaluated. Conclusion PTU is a valuable adjunct tool to record symmetry of diaphragmatic movement as a measure of correct ETT placement in labour ward for ELBW infants. HIGH-FLOW NASAL CANNULAE FOR RESPIRATORY SUPPORT OF PRETERM INFANTS: A REVIEW OF THE EVIDENCE Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, AustraliaBackground High-flow nasal cannulae (HFNC) are gaining in popularity as a form of non-invasive respiratory support for preterm infants in neonatal intensive care units around the world. They are proposed as an alternative to nasal continuous positive airway pressure (NCPAP) for treating respiratory distress in a variety of clinical situations, including post-extubation support, primary therapy from birth, and to 'wean' from NCPAP. Objectives To present and discuss the available evidence for the use of HFNC in various roles in the preterm population. Methods We performed an internet-based literature search for relevant, original research articles (both randomised and not) on the use of HFNC in preterm infants. Results 18 studies were included in the review. Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size, and may vary according to the amount of leak around the prongs. HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but perhaps only at flow rates >2 Litres per minute. Based on available published evidence, the efficacy and safety of HFNC in preterm infants remain to be determined. Conclusions There is increasing evidence from clinical trials to support the use of HFNC treatment of preterm infants with respiratory failure, however uncertainty remains about efficacy, safety and optimal flow rates. Until the results of ...
Background Hydrops fetalis is a potentially lethal condition diagnosed on the basis of excess fluid accumulation in at least two potential spaces including ascites, pericardial effusion, pleural effusion, or skin. Data on the prognosis of this condition are limited. Aim To describe the outcomes of infants born with hydrops fetalis in a single centre over an 11 year period. Method We performed a retrospective case review of inborn neonates diagnosed with hydrops fetalis admitted to the neonatal unit (NICU) at The Royal Women’s Hospital between 2001 and 2012. Cases were identified through a search of neonatal and obstetric databases. Data were extracted from maternal and neonatal case files, along with electronic reports from pathology and radiology databases and the obstetric and neonatal databases. Results We identified 193 fetuses with hydrops continuing beyond 17 weeks gestation. The outcome of 151 pregnancies occurred at the Royal Women’s Hospital. 73 cases resulted in fetal death in utero or termination, in 23 cases the hydrops resolved antenatally and 52 infants were born alive with hydrops. The most common causes of hydrops were idiopathic (35%); cardiac (19%); non-cardiac anomaly (15%) and syndromal (12%). Of the 52 infants born alive, 20 (39%) survived to hospital discharge. Survival with idiopathic hydrops was 28%. Conclusions Overall survival in infants born alive with hydrops was 39%. Idiopathic hydrops was the most common diagnosis and had one of the poorest survival rates.
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