BACKGROUND AND PURPOSE:Hypotension and bradycardia are common in carotid artery stenting (CAS) and are particularly worrisome in the high risk patient who is typically referred for CAS. The purpose of this work was to assess the incidence and predictors of hypotension and bradycardia and the risk of their delayed occurrence after CAS.
OBJECTIVE: our objective is to assess the positive distending pressure generated by high flow nasal cannula and nasal continuous positive airway pressure by measuring the end esophageal pressure in premature infants. STUDY DESIGN: This is a pilot, non-randomized, open label, uncontrolled, crossover assignment study that included neonates born with a birth weight of 1750 grams or less and receiving nCPAP ventilatory support for 24 hrs or more and requiring FiO2 21-50% on nCPAP. Each infant was started on nCPAP at 4, 6 and 8 cm H 2 O then on three levels of HHHFNC, 4 L/min, 6 L/min and 8 L/min with 4 hours interval on each flow level. Esophageal pressure (EP), apnea of prematurity, FiO2 requirements and bradycardia were recorded during the different levels of CPAP and HHHFNC use.
RESULTS:The study showed that there were no complications observed during the study such as pneumothorax. It showed that EP created by the three different levels of HHHFNC were slightly higher than that EPs created by the three different levels of nCPAP, but statistically not significant. There was no significant change in the FiO2 requirements during the study. There was a trend towards the improvement of oxygen saturation in HHHFNC at different levels and it was statistically significant when 8 L/min was used (P 0.0214). The rates of bradycardia and apnea in nCPAP and HHHFNC were low and statistically were not significant, however the episodes of bradycardia were less in HHHFNC and they were statistically significant at the level of 6 L/min. CONCLUSIONS: HHHFNC in premature infants was well-tolerated with no adverse side effects such as pneumothorax, desaturation, apnea and bradycardia. The study also showed that HHHFNC was able to deliver distending pressure equal to nCPAP. Moreover, we have observed a significant improvement in oxygen saturation when higher levels of HHHFNC was used, most probably due to the improvement of infant comfort which is a noticeable feature of HHHFNC.
patients who were confirmed with COVID-19 postoperatively (20.4%) compared with preoperatively (9.1%). Care and staffing needs differ, so preoperative COVID-19 testing and diagnoses can be helpful to ensure needs are met before complications arise. Strategies can be implemented to address more emergent surgeries where prior testing is not feasible. When making discussions, the mother, neonate, and HCWs should be considered to minimize risk and improve safety for all involved. Future research and studies should look at the clinical benefits and risks of the testing pathway, PPE use and its impact on HCW outcomes, and risks and benefits of maternal-neonate interaction after the mother tests positive for COVID-19.
Background and objectives:
To determine the effects of intravenous immunoglob-ulin (IVIg) on the course of late hyporegenerative anemia and the requirement for exchange transfusions, phototherapy and top-up red blood cell transfusions due to rhesus hemolytic dis-ease of the newborn (Rh-HDN).
Patients and methods:
This is retrospective cohort study of newborns with Rh-HDN who were treated with or without IVIg. Relevant maternal and neonatal data were obtained and analyzed. All infants were followed up as outpatients for a period of 2-3 months, and during the follow ups, complete blood counts (RBCs) were performed every two weeks to diagnose late hyporegenerative anemia.
Results:
Sixty-six infants with Rh-HDN were enrolled in this study (42 in the IVIg group and 24 in the no-IVIg group). We observed no significant differences between the two groups in terms of maternal age, number of previous children affected with Rh-HDN, intrauterine transfusions, gestational age (GA), birth weight (BW), Apgar scores at the 1st or 5th minutes, exchange transfusions, or days on phototherapy. The serum bilirubin immediately after birth and the maximum serum bilirubin during the hospital course were significantly higher in the IVIG group (P = 0.0035 and P = 0.0225, respectively). Although there were no statistically significant dif-ferences, there was a trend toward the late anemia in the IVIg group being diagnosed and resolved earlier than in the no-IVIg group. Additionally, a greater proportion of the IVIg group required three or more top-up transfusions compared to the no-IVIg group, but this difference was not statistically significant.
Conclusion:
IVIg might have had an effect on the early development of late anemia and might have shortened the duration of late anemia relative to the infants who did not receive IVIg. The exchange transfusions and the days on phototherapy were not affected by IVIg.
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