Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

Kaiser, Jeffrey R.; Gauss, C. Heath; Williams, David

doi:10.1038/sj.jp.7211848

Cited by 42 publications

(33 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As suctioning spontaneously breathing newborns is not beneficial and may even be harmful, nasoor oropharyngeal suctioning is only recommended if the mouth and nose are visibly obstructed by secretions or meconium [19] . Suctioning is reported to be associated with an increased risk of intraventricular hemorrhage, apnea, vagal reflex bradycardia, and delayed resuscitation [20,21] . Despite these recommendations, airway suctioning was performed in 5% of the newborn infants.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

et al. 2015

View full text Add to dashboard Cite

Background: Most newborns manage the transition from intra- to extrauterine life without interventions, yet neonatal morbidity caused by failure of transition remains an important health problem. Objective: To determine the incidence of neonatal stabilization and resuscitation measures and guideline compliance during the first minutes after birth. Methods: This is a prospective, observational study of all births in three Norwegian hospitals. All interventions performed, including suctioning, use of pulse oximetry, continuous positive airway pressure (CPAP), positive pressure ventilation (PPV), supplemental oxygen, intubation, and administration of drugs, were registered at every on-call team shift during the study period. Results: A total of 1,507 live-born infants were included, of whom 264 (18%) were brought to the resuscitation crib. Oropharyngeal suctioning was performed in 77 (5%), deep blind suctioning was carried out in 10 (1%) and 84 (6%) were monitored using pulse oximetry. PPV was provided in 58 cases (4%) - 8 (21%) of <34 weeks and 50 (3%) of ≥34 weeks of gestation. Sustained inflation is not routinely used in these departments. CPAP (without PPV) was provided in 17 cases (1%) - 4 (0.3%) were intubated and ventilated through the endotracheal tube. Supplemental oxygen was given to 39 infants (3%) - 9 without pulse oximetry monitoring. The median (interquartile range) birth weight and gestational age of the newborns requiring PPV and/or CPAP were 3,220 g (2,643-3,858) and 39 weeks (37-41), respectively. Conclusion: In this study, the need for resuscitation and/or stabilization measures was commonly considered, and 4% of all newborns received PPV. Despite strong guideline emphasis on the use of pulse oximetry to guide oxygen administration, many infants received oxygen treatment without pulse oximetry monitoring.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

et al. 2015

View full text Add to dashboard Cite

show abstract

“…3,15,[25][26][27] In the prior studies, cerebral autoregulation was found to be influenced by hypercapnia and associated with severe IVH. In addition, changes to cerebral hemodynamics occurred during surfactant administration and tracheal suctioning.…”

Section: Introductionmentioning

confidence: 99%

The Ontogeny of Cerebrovascular Pressure Autoregulation in Premature Infants

Rhee

Fraser²,

Kibler

et al. 2016

Acta Neurochirurgica Supplement

View full text Add to dashboard Cite

Objective-To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle.Study design-The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179), with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-hour sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: 1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); 2) mean ABP and mean CBF velocity (Mx); and 3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle.Results-Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4, and 0.4; p<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=−0.3; p<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=−0.06; p=0.05). Multivariate analysis confirmed that both GA (p<0.001) and "effective cerebral perfusion pressure" (ABP minus critical closing pressure; p<0.01) were associated with Sx. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusion-Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the critical closing pressure was associated with dysautoregulation.

show abstract

“…Therefore, physical factors that can change these two parameters can affect CBF. Moderate changes in the mean arterial blood pressure (MABP) have not been found to cause significant changes in CBF of infants with intact cerebral autoregulation [9]. If abrupt changes in the MABP are prevented, and in the absence of hypoglycemia and anemia that can increase CBF, the most important factors affecting the CBF of mechanically ventilated infants with intact CBF autoregulation are considered to be the arterial partial pressures of carbon dioxide and oxygen [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

A computerized decision support system to predict the variations in the cerebral blood flow of mechanically ventilated infants

Tehrani¹

2013

Computers in Biology and Medicine

View full text Add to dashboard Cite

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

Cited by 42 publications

References 36 publications

Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

The Ontogeny of Cerebrovascular Pressure Autoregulation in Premature Infants

A computerized decision support system to predict the variations in the cerebral blood flow of mechanically ventilated infants

Contact Info

Product

Resources

About