V posledních letech začínají na neonatologických odděleních pracovat jako členové multidisciplinárního týmu také kliničtí logopedi. Vzhledem k absenci doporučeného postupu pro práci klinických logopedů na tomto typu oddělení se množí nejasnosti ohledně toho, jaké terapie je klinický logoped oprávněn provádět. Zajímal nás názor pracovníků neonatologických oddělení na to, zda považují klinického logopeda za kompetentního v provádění následujících typů terapií: vývojová péče, bazální stimulace, Bobath handling, respirační fyzioterapie a handling, viscerální manipulace, kraniosakrální terapie a metody CBF (cue-based feeding), tedy techniky responsivního vedení příjmu potravy dle klíčových znaků chování dítěte. Využita byla metoda dotazníku, jenž byl rozeslán do všech perinatologických center II. a III. stupně. Osloveni byli pracovníci následujících profesí: lékař, sestra, fyzioterapeut, ergoterapeut a klinický logoped. Na otázku, zda může logoped provádět vývojovou péči, bazální stimulaci, Bobath koncept a viscerální manipulaci, byl respondenty z řad lékařů, sester a fyzioterapeutů vyjádřen spíše souhlas, počty kladných odpovědí se pohybovaly v rozmezí 50–65 %. U otázky na kompetenci logopedů v provádění respirační fyzioterapie a handlingu a kraniosakrální terapie převažoval nesouhlas, ten vyjádřilo více než 90 % respondentů. Oproti tomu většina respondentů (97,5 %) souhlasila s názorem, že logoped může provádět techniky vedení příjmu potravy dle klíčových znaků chování kojence. Cílem tohoto článku je informovat pracovníky z řad lékařských i nelékařských profesí působících na neonatologickém oddělení o možnostech využití dalších podpůrných doplňkových terapií, které je klinický logoped po proškolení oprávněn vykonávat.
In recent years, clinical speech therapists have begun to assume roles within the multidisciplinary teams that care for neonates in neonatal wards. In the absence of a recommended procedure for the work of clinical speech and language therapists in this type of ward, there is confusion as to which therapies clinical speech and language therapists are authorised to perform. The objective of this study was to ascertain the opinion of neonatal ward staff as to the competence of clinical speech therapists in performing the following types of therapies: developmental care, basal stimulation, Bobath handling, respiratory physiotherapy and handling, visceral manipulation, craniosacral therapy and cue-based feeding (CBF) methods, namely guiding feeding according to the child’s key behavioural features. A questionnaire was distributed to all perinatology centres at levels II and III. The following professionals were consulted: physicians, nurses, physiotherapists, occupational therapists and clinical speech therapists. When asked whether the speech therapist could perform developmental care, basal stimulation, the Bobath concept and visceral manipulation, the respondents from the medical and nursing professions, as well as physiotherapists, indicated that they believed a therapist to be competent in these areas, with the numbers of positive responses ranging from 50% to 65%. With regard to the question of competence in performing respiratory physiotherapy and craniosacral therapy, a significant proportion of respondents (more than 90%) expressed disagreement with the view that speech therapists are capable of performing these therapies. Conversely, the majority of respondents (97.5%) indicated that they believed speech therapists can effectively utilise feeding management tech- niques in accordance with the infant’s key behavioural features.
OBJECTIVE: Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. DESIGN AND INTERVENTION: International online survey. RESULTS: Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%-98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had <2 years of experience, and only 71 units (13%) had >5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome. The main barriers for implementation were lack of experience with technical aspects and/or image interpretation. Most units indicated that specific courses and an international guideline on neonatal LU could promote uptake of this technique. CONCLUSIONS: Although LU has been adopted in neonatal care in most European countries, the uptake is highly variable. The main indications are diagnosis of lung disease, evaluation of acute clinical deterioration and guidance of surfactant. Implementation may be improved by developing courses and publishing an international guideline.
- MeSH
- jednotky intenzivní péče o novorozence * MeSH
- lékařská praxe - způsoby provádění statistika a číselné údaje MeSH
- lidé MeSH
- novorozenec MeSH
- plíce * diagnostické zobrazování MeSH
- průzkumy a dotazníky MeSH
- syndrom respirační tísně novorozenců diagnostické zobrazování terapie MeSH
- ultrasonografie * metody MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
IMPORTANCE: Red blood cell (RBC) transfusions are frequently administered to preterm infants born before 32 weeks of gestation in the neonatal intensive care unit (NICU). Two randomized clinical trials (Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants [ETTNO] and Transfusion of Prematures [TOP]) found that liberal RBC transfusion thresholds are nonsuperior to restrictive thresholds, but the extent to which these results have been integrated into clinical practice since publication in 2020 is unknown. OBJECTIVE: To describe neonatal RBC transfusion practice in Europe. DESIGN, SETTING, AND PARTICIPANTS: This international prospective observational cohort study collected data between September 1, 2022, and August 31, 2023, with a 6-week observation period per center, from 64 NICUs in 22 European countries. Participants included 1143 preterm infants born before 32 weeks of gestation. EXPOSURE: Admission to the NICU. MAIN OUTCOMES AND MEASURES: Study outcome measures included RBC transfusion prevalence rates, cumulative incidence, indications, pretransfusion hemoglobin (Hb) levels, volumes, and transfusion rates, Hb increment, and adverse effects of RBC transfusion. RESULTS: A total of 1143 preterm infants were included (641 male [56.1%]; median gestational age at birth, 28 weeks plus 2 days [IQR, 26 weeks plus 2 days to 30 weeks plus 2 days]; median birth weight, 1030 [IQR, 780-1350] g), of whom 396 received 1 or more RBC transfusions, totaling 903 transfusions. Overall RBC transfusion prevalence rate during postnatal days 1 to 28 was 3.4 transfusion days per 100 admission days, with considerable variation across countries, only partly explained by patient mix. By day 28, 36.5% (95% CI, 31.6%-41.5%) of infants had received at least 1 transfusion. Most transfusions were given based on a defined Hb threshold (748 [82.8%]). Hemoglobin levels before transfusions indicated for threshold were below the restrictive thresholds set by ETTNO in 324 of 729 transfusions (44.4%) and TOP in 265 of 729 (36.4%). Conversely, they were between restrictive and liberal thresholds in 352 (48.3%) and 409 (56.1%) transfusions, respectively, and above liberal thresholds in 53 (7.3%) and 55 (7.5%) transfusions, respectively. Most transfusions given based on threshold had volumes of 15 mL/kg (470 of 738 [63.7%]) and were administered over 3 hours (400 of 738 [54.2%]), but there was substantial variation in dose and duration. CONCLUSIONS AND RELEVANCE: In this cohort study of very preterm infants, most transfusions indicated for threshold were given for pretransfusion Hb levels above restrictive transfusion thresholds evaluated in recent trials. These results underline the need to optimize practices and for implementation research to support uptake of evidence.
- MeSH
- jednotky intenzivní péče o novorozence * statistika a číselné údaje MeSH
- lidé MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- prospektivní studie MeSH
- transfuze erytrocytů * statistika a číselné údaje metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Geografické názvy
- Evropa MeSH
OBJECTIVE: This study aims to evaluate the performance of the fabian-Predictive-Intelligent-Control-of-Oxygenation (PRICO) system for automated control of the fraction of inspired oxygen (FiO2). DESIGN: Multicentre randomised cross-over study. SETTING: Five neonatal intensive care units experienced with automated control of FiO2 and the fabian ventilator. PATIENTS: 39 infants: median gestational age of 27 weeks (IQR: 26-30), postnatal age 7 days (IQR: 2-17), weight 1120 g (IQR: 915-1588), FiO2 0.32 (IQR: 0.22-0.43) receiving both non-invasive (27) and invasive (12) respiratory support. INTERVENTION: Randomised sequential 24-hour periods of automated and manual FiO2 control. MAIN OUTCOME MEASURES: Proportion (%) of time in normoxaemia (90%-95% with FiO2>0.21 and 90%-100% when FiO2=0.21) was the primary endpoint. Secondary endpoints were severe hypoxaemia (<80%) and severe hyperoxaemia (>98% with FiO2>0.21) and prevalence of episodes ≥60 s at these two SpO2 extremes. RESULTS: During automated control, subjects spent more time in normoxaemia (74%±22% vs 51%±22%, p<0.001) with less time above and below (<90% (9%±8% vs 12%±11%, p<0.001) and >95% with FiO2>0.21 (16%±19% vs 35%±24%) p<0.001). They spent less time in severe hyperoxaemia (1% (0%-3.5%) vs 5% (1%-10%), p<0.001) but exposure to severe hypoxaemia was low in both arms and not different. The differences in prolonged episodes of SpO2 were consistent with the times at extremes. CONCLUSIONS: This study demonstrates the ability of the PRICO automated oxygen control algorithm to improve the maintenance of SpO2 in normoxaemia and to avoid hyperoxaemia without increasing hypoxaemia.
- MeSH
- hyperoxie prevence a kontrola MeSH
- hypoxie MeSH
- jednotky intenzivní péče o novorozence * MeSH
- klinické křížové studie * MeSH
- kyslík krev aplikace a dávkování MeSH
- lidé MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- oxygenoterapie metody škodlivé účinky přístrojové vybavení MeSH
- oxymetrie metody MeSH
- saturace kyslíkem * MeSH
- umělé dýchání škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pragmatická klinická studie MeSH
- randomizované kontrolované studie MeSH
OBJECTIVE: To evaluate the efficacy of automatic oxygen control (A-FiO2) in reducing the extremes of oxygen saturations (SpO2<80% and SpO2>98%) in preterm infants on high-flow nasal cannula (HFNC) respiratory support using Vapotherm Precision Flow. DESIGN: A parallel-arm randomised controlled trial. SETTING: A level-III neonatal intensive care unit. PATIENTS: Preterm infants born <33 (23+0 to 32+6) weeks receiving HFNC as respiratory support. INTERVENTIONS: A-FiO2 versus manual (M-FiO2) oxygen control during the full course of HFNC support. OUTCOMES: The primary outcome of this study is percentage of time spent in extreme oxygen saturations (<80% and >98%) in preterm infants when receiving HFNC as respiratory support. Secondary outcomes were time with SpO2 between 90% and 95% plus time >95% without supplemental oxygen. RESULTS: 60 infants were randomised equally to either A-FiO2 or M-FiO2 arm. Their baseline characteristics were comparable. They spent a median of 5.3 (IQR: 2.0-8.4) and 6.5 (IQR: 2.9-13.7) days in the study, A-FiO2 and M-FiO2, respectively. The percentage of time spent in SpO2<80% (median of 0.4% (0.1%-0.8%) vs 1.6% (0.6%-2.6%), p=0.002) and >98% (median 0.2% (0.1%-0.9%) vs 1.9% (0.7%-4%), p<0.001) were significantly lower in A-FiO2 compared with M-FiO2. The difference in median percentage of time in target range between the two arms was 26% (81% (74%-93%) in A-FiO2 vs 55% (48%-72%) in M-FiO2). CONCLUSION: A-FiO2 was associated with statistically significant reduction in the percentage of time spent in extremes of saturation when compared with M-FiO2 in preterm infants receiving HFNC. TRIAL REGISTRATION NUMBER: NCT04687618.
BACKGROUND: The SafeBoosC project aims to test the clinical value of non-invasive cerebral oximetry by near-infrared spectroscopy in newborn infants. The purpose is to establish whether cerebral oximetry can be used to save newborn infants' lives and brains or not. Newborns contribute heavily to total childhood mortality and neonatal brain damage is the cause of a large part of handicaps such as cerebral palsy. The objective of the SafeBoosC-IIIv trial is to evaluate the benefits and harms of cerebral oximetry added to usual care versus usual care in mechanically ventilated newborns. METHODS/DESIGN: SafeBoosC-IIIv is an investigator-initiated, multinational, randomised, pragmatic phase-III clinical trial. The inclusion criteria will be newborns with a gestational age more than 28 + 0 weeks, postnatal age less than 28 days, predicted to require mechanical ventilation for at least 24 h, and prior informed consent from the parents or deferred consent or absence of opt-out. The exclusion criteria will be no available cerebral oximeter, suspicion of or confirmed brain injury or disorder, or congenital heart disease likely to require surgery. A total of 3000 participants will be randomised in 60 neonatal intensive care units from 16 countries, in a 1:1 allocation ratio to cerebral oximetry versus usual care. Participants in the cerebral oximetry group will undergo cerebral oximetry monitoring during mechanical ventilation in the neonatal intensive care unit for as long as deemed useful by the treating physician or until 28 days of life. The participants in the cerebral oximetry group will be treated according to the SafeBoosC treatment guideline. Participants in the usual care group will not receive cerebral oximetry and will receive usual care. We use two co-primary outcomes: (1) a composite of death from any cause or moderate to severe neurodevelopmental disability at 2 years of corrected age and (2) the non-verbal cognitive score of the Parent Report of Children's Abilities-Revised (PARCA-R) at 2 years of corrected age. DISCUSSION: There is need for a randomised clinical trial to evaluate cerebral oximetry added to usual care versus usual care in mechanically ventilated newborns. TRIAL REGISTRATION: The protocol is registered at www. CLINICALTRIALS: gov (NCT05907317; registered 18 June 2023).
- MeSH
- dítě MeSH
- jednotky intenzivní péče o novorozence MeSH
- kojenec MeSH
- lidé MeSH
- mozek MeSH
- mozkový krevní oběh MeSH
- novorozenec MeSH
- oxymetrie * metody MeSH
- randomizované kontrolované studie jako téma MeSH
- umělé dýchání * škodlivé účinky MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
OBJECTIVE: The objective of this study was to compare two different modes of ventilation in maintaining oxygen saturation (SpO2) in target range (90%-95%) in ventilated preterm infants cared for with automatic control of oxygen delivery (A-FiO2). DESIGN: A single-centre randomised crossover study. SETTINGS: A level III neonatal intensive care unit. PATIENTS: Preterm infants receiving mechanical ventilation and oxygen requirement >21%. INTERVENTIONS: Volume guarantee (VG) vs volume controlled ventilation (VCV) modes with automatic oxygen control (A-FiO2). OUTCOMES: The primary outcome of this study was the proportion of time spent with oxygen saturations in the target range (90%-95%) . RESULTS: Nineteen preterm infants with a median gestation age 25 weeks (IQR: 24-28) and birth weight 685 g (IQR: 595-980) were enrolled in the study. There was no significant difference in primary outcome of median proportion of time spent in target saturation between the two arms (72% (57-81) in VG vs 75% (58-83) in VCV; p=0.98). There was no significant difference in the secondary outcomes of time spent in SpO2 <80% (0.03% vs 0.14%; p=0.51), time spent in SpO2 >98% (0.50% vs 0.08%; p=0.54), the median FiO2 (31% vs 29%; p=0.51) or manual adjustments carried out between VG and VCV, respectively. The number of episodes of prolonged hypoxaemia and hyperoxaemia were similar in the two groups. CONCLUSION: There was no significant difference in time spent in target SpO2 range between VG and VCV when A-FiO2 was used as the FiO2 controller in this crossover randomised control study. TRIAL REGISTRATION NUMBER: NCT03865069.
- MeSH
- jednotky intenzivní péče o novorozence MeSH
- klinické křížové studie MeSH
- kyslík terapeutické užití MeSH
- lidé MeSH
- neinvazivní ventilace MeSH
- novorozenec nedonošený * MeSH
- novorozenec MeSH
- oxygenoterapie metody MeSH
- oxymetrie metody MeSH
- syndrom respirační tísně novorozenců prevence a kontrola MeSH
- umělé dýchání metody MeSH
- ventilace umělá s přerušovaným přetlakem * MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- randomizované kontrolované studie MeSH
Oxygen is the most common drug used in the critical care of infants. There is significant morbidity and mortality associated with excess or inadequate levels. For this reason, an important element of many therapeutic interventions in the ICU requires assessment of their acute impact on oxygenation. It is common to normalize the arterial level of oxygen with the fraction of inspired oxygen (PF-ratio). Further, a change may often be more important than the absolute level. Though the PF-ratio is often reported, it was surmised that the rarely reported, relative magnitude of change in PF-ratio might be a useful metric for assessing the stability and effectiveness of therapy. Therefore, individual patient data from two different studies were evaluated. The cases included periods of therapeutic intervention and periods without intervention, thus permitting the evaluation of the PF-ratio's potential sensitivity to change and thresholds for relevant change. During surfactant administration in extremely preterm infants, the PF-ratio improved at least 25% in 91% of the infants, while 9% showed less than a 10% change. During high-frequency oscillatory rescue in children, the PF-ratio improved at least 25% in 76% of the infants, while 8% showed less than a 10% change. Consideration of thresholds of 50% and 5% reflected low prevalence. In periods of routine care, the prevalence of marked changes was less prevalent but still common (6% and 55%) and periods of little change more prevalent (21% and 21%). We believe this initial work supports the feasibility of using the magnitude of change in PF-ratio and provides a useful stimulus for additional evaluations.
- MeSH
- hyperoxie komplikace terapie MeSH
- hypoxie komplikace terapie MeSH
- jednotky intenzivní péče o novorozence MeSH
- lidé MeSH
- novorozenci extrémně nezralí MeSH
- oxygenoterapie * metody ošetřování škodlivé účinky MeSH
- saturace kyslíkem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- metaanalýza MeSH
- práce podpořená grantem MeSH
Necrotising enterocolitis (NEC) is a devastating condition with high morbidity and mortality seen predominately in preterm infants. Multiple factors are associated with the pathogenesis of NEC. The widespread use of antibiotics in the neonatal intensive care unit might play a role in the pathogenesis of NEC in preterm infants. This review provides a summary on the intestinal microbiota in preterm infants with a focus on how antibiotic exposure may reduce the biodiversity of the intestinal microbiota and may predispose preterm infants to NEC. CONCLUSION: Prolonged antibiotic therapy has been suggested as a risk factor for the development of NEC in preterm infants.
- MeSH
- antibakteriální látky škodlivé účinky MeSH
- jednotky intenzivní péče o novorozence MeSH
- kojenec MeSH
- lidé MeSH
- nekrotizující enterokolitida * chemicky indukované MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- střevní mikroflóra * MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
