Sedation in Critically Ill Children with Respiratory Failure

Vet, Nienke J.; Kleiber, Niina; Ista, Erwin; Hoog, Matthijs de; Wildt, Saskia N. de

doi:10.3389/fped.2016.00089

Cited by 37 publications

(71 citation statements)

References 150 publications

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“…opioids and benzodiazepines). Although we did not analyze potential symptoms of withdrawal or withdrawal prevention management (for Review on weaning treatment, see [26]), we confirmed that extended administration of opioids and benzodiazepines was indicated specifically for weaning management as per primary team and/or pain service consult notes. In this pilot case report, subjects were categorized and named as Preterm 1, 2, 3 and Term 1, 2, 3 in order of increasing corrected age at time of post-Foker MRI scan.…”

Section: Study Design and Subjectsmentioning

confidence: 81%

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

et al. 2019

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We previously showed that infants born with long-gap esophageal atresia (LGEA) demonstrate clinically significant brain MRI findings following repair with the Foker process. The current pilot study sought to identify any pre-existing (PRE-Foker process) signs of brain injury and to characterize brain and corpus callosum (CC) growth. Preterm and full-term infants (n = 3/group) underwent non-sedated brain MRI twice: before (PRE-Foker scan) and after (POST-Foker scan) completion of perioperative care. A neuroradiologist reported on qualitative brain findings. The research team quantified intracranial space, brain, cerebrospinal fluid (CSF), and CC volumes. We report novel qualitative brain findings in preterm and full-term infants born with LGEA before undergoing Foker process. Patients had a unique hospital course, as assessed by secondary clinical end-point measures. Despite increased total body weight and absolute intracranial and brain volumes (cm3) between scans, normalized brain volume was decreased in 5/6 patients, implying delayed brain growth. This was accompanied by both an absolute and relative CSF volume increase. In addition to qualitative findings of CC abnormalities in 3/6 infants, normative CC size (% brain volume) was consistently smaller in all infants, suggesting delayed or abnormal CC maturation. A future larger study group is warranted to determine the impact on the neurodevelopmental outcomes of infants born with LGEA.

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Section: Study Design and Subjectsmentioning

confidence: 81%

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

et al. 2019

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“…opioids and benzodiazepines). Although we did not analyze potential symptoms of withdrawal or withdrawal prevention management (for Review on weaning treatment see (Vet et al, 2016)), we confirmed administration of opioids and benzodiazepines was indicated specifically for weaning management as per primary team and/or pain service consult notes. Representative timeline illustrating sequence of perioperative critical care was presented elsewhere (Hodkinson et al, 2019; Mongerson et al, 2019).…”

Section: Methodsmentioning

confidence: 96%

Quantitative MRI study of infant regional brain size following surgery for long‐gap esophageal atresia requiring prolonged critical care

Mongerson

Jennings

Zurakowski

et al. 2019

Intl J of Devlp Neuroscience

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Introduction Little is known regarding the impact of concurrent critical illness and thoracic noncardiac perioperative critical care on postnatal brain development. Previously, we reported smaller total brain volumes in both critically ill full‐term and premature patients following complex perioperative critical care for long‐gap esophageal atresia (LGEA). Our current report assessed trends in regional brain sizes during infancy, and probed for any group differences. Methods Full‐term (n = 13) and preterm (n = 13) patients without any previously known neurological concerns, and control infants (n = 16), underwent non‐sedated 3 T MRI in infancy (<1 year old). T2‐weighted images underwent semi‐automated brain segmentation using Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS). Regional tissue volumes of the forebrain, deep gray matter (DGM), cerebellum, and brainstem are presented as absolute (cm3) and normalized (% total brain volume (%TBV)) values. Group differences were assessed using a general linear model univariate analysis with corrected age at scan as a covariate. Results Absolute volumes of regions analyzed increased with advancing age, paralleling total brain size, but were significantly smaller in both full‐term and premature patients compared to controls. Normalized volumes (%TBV) of forebrain, DGM, and cerebellum were not different between subject groups analyzed. Normalized brainstem volumes showed group differences that warrant future studies to confirm the same finding. Discussion Both full‐term and premature critically ill infants undergoing life‐saving surgery for LGEA are at risk of smaller total and regional brain sizes. Normalized volumes support globally delayed or diminished brain growth in patients. Future research should look into neurodevelopmental outcomes of infants born with LGEA.

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“…Patients' eligibility criteria were: full-term (37 to 42 weeks GA at birth) and moderate-to-late preterm (28 to 36 weeks GA at birth) patients <1 year gestation-corrected age that underwent surgery for Foker process for LGEA repair 1,22 . We selected infants that required prolonged postoperative sedation (≥5 days) associated with development of pharmacological dependence to drugs of sedation 11,[23][24][25] . Representative timeline illustrating sequence of perioperative critical care was presented previously 6,26 .…”

Section: Methodsmentioning

confidence: 99%

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

Sci Rep

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previous studies in preterm infants report white matter abnormalities of the corpus callosum (cc) as an important predictor of neurodevelopmental outcomes. our cross-sectional study aimed to describe qualitative and quantitative cc size in critically ill infants following surgical and critical care for longgap esophageal atresia (LGeA)-in comparison to healthy infants-using MRi. non-sedated brain MRi was acquired for full-term (n = 13) and premature (n = 13) patients following treatment for LGEA, and controls (n = 20) <1 year corrected age. A neuroradiologist performed qualitative evaluation of T1weighted images. ITK-SNAP was used for linear, 2-D and 3-D manual CC measures and segmentations as part of CC size quantification. Qualitative MRI analysis indicated underdeveloped CC in both patient groups in comparison to controls. We show no group differences in mid-sagittal CC length. Although 2-D results were inconclusive, volumetric analysis showed smaller absolute (F(2,42) = 20.40, p < 0.001) and normalized (F(2,42) = 16.61, p < 0.001) CC volumes following complex perioperative treatment for LGeA in both full-term and premature patients, suggesting delayed or diminished cc growth in comparison to controls, with no difference between patient groups. Future research should look into etiology of described differences, neurodevelopmental outcomes, and role of the CC as an early marker of neurodevelopment in this unique infant population.

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Sedation in Critically Ill Children with Respiratory Failure

Cited by 37 publications

References 150 publications

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

Quantitative MRI study of infant regional brain size following surgery for long‐gap esophageal atresia requiring prolonged critical care

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

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