BACKGROUND: User errors in managing heated humidifiers (HHs) have been suggested to be a source o... more BACKGROUND: User errors in managing heated humidifiers (HHs) have been suggested to be a source of nasal burns in newborns treated with nasal CPAP. This study evaluated the risk of burns by reproducing 3 typical errors concerning the use of HHs. METHODS: Six HHs were tested on a bench in a traditional nasal CPAP setup: PMH5000, Aircon (Wilamed); MR730, MR850, MR950 (Fisher & Paykel); and H900 (Hamilton). Temperature was measured at the end of the inspiratory tubing limb. Errors tested were (1) misconnection of the HH thermal probes (NoProbe), (2) absence of gas flow while the HH is on (NoFlow), and (3) unsuitable repeated acknowledgment of the HH alarm (NoAlarm). These errors were combined in 3 standardized scenarios: (1) NoProbe + NoFlow + NoAlarm; (2) NoProbe + NoAlarm, and (3) NoFlow + NoAlarm. The NoProbe + NoFlow + NoAlarm and NoProbe + NoAlarm scenarios were not tested in the H900 and MR950 because the proprietary circuits of these HHs are equipped with embedded probes. RESULT...
Background and Purpose: Cardiac pathologies are the second most frequent risk factor (RF) in chil... more Background and Purpose: Cardiac pathologies are the second most frequent risk factor (RF) in children with arterial ischemic stroke (AIS). This study aimed to analyze RFs for AIS in children with cardiac disease and cardiac intervention. Methods: Data were drawn from the Swiss Neuropediatric Stroke Registry. Patients with cardiac disease and postprocedural AIS registered from 2000 until 2015 were analyzed for the cause of cardiac disease and for potential RFs. Results: Forty-seven out of 78 children with cardiac disease had a cardiac intervention. Of these, 36 presented a postprocedural AIS. Median time from cardiac intervention to symptom onset was 4 days (interquartile range, 2–8.5); time to diagnosis of AIS was 2 days (interquartile range, 0–5.8). Main RFs for postprocedural AIS were hypotension, prosthetic cardiac material, right-to-left shunt, arrhythmias, low cardiac output, and infections. Conclusions: In children with postprocedural AIS, time to diagnosis was delayed. Most p...
Pediatric Index of Mortality (PIM) 2 score is used in pediatric intensive care unit (PICU) to pre... more Pediatric Index of Mortality (PIM) 2 score is used in pediatric intensive care unit (PICU) to predict the patients’ risk of death. The performance of this model has never been assessed in Switzerland. The aim of this study was to evaluate the performance of the PIM2 score in the whole cohort and in pre-specified diagnostic subgroups of patients admitted to PICUs in Switzerland. All children younger than 16 years admitted to any PICU in Switzerland between January 1, 2012 and December 31, 2017 were included in the study. A total of 22,382 patients were analyzed. Observed mortality was 2%, whereas mortality predicted by PIM2 was 4.2% (SMR = 0.47, 95% CI, 0.42–0.52). Calibration was also poor across the deciles of mortality risks (p < 0.001). The AUC-ROC for the entire cohort was 0.88 (95% CI, 0.87–0.90). Calibration varied significantly according to primary diagnosis. Conclusion: The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. The PIM 2 score tends to under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest. What is Known: •PIM2 score is a widely used mortality prediction model in PICU. •PIM2 performance among uncommon but clinically relevant diagnostic subgroups of patients is unknown. •The performance of PIM2 score has never been assessed in Switzerland. What is New: •The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. •Calibration varies significantly according to primary diagnosis. The PIM 2 score under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest. What is Known: •PIM2 score is a widely used mortality prediction model in PICU. •PIM2 performance among uncommon but clinically relevant diagnostic subgroups of patients is unknown. •The performance of PIM2 score has never been assessed in Switzerland. What is New: •The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. •Calibration varies significantly according to primary diagnosis. The PIM 2 score under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest.
To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric int... more To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. Cross-sectional electronic survey. The survey was distributed to the ESPNIC mailing list and to researchers in different European centers. One hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respi...
To determine the effect of prone positioning on ventilation distribution in children with acute r... more To determine the effect of prone positioning on ventilation distribution in children with acute respiratory distress syndrome. Prospective observational study. Paediatric Intensive Care at Red Cross War Memorial Children&amp;amp;amp;amp;#39;s Hospital, Cape Town, South Africa. Mechanically ventilated children with acute respiratory distress syndrome. Electrical impedance tomography measures were taken in the supine position, after which the child was turned into the prone position, and subsequent electrical impedance tomography measurements were taken. Thoracic electrical impedance tomography measures were taken at baseline and after 5, 20, and 60 minutes in the prone position. The proportion of ventilation, regional filling characteristics, and global inhomogeneity index were calculated for the ventral and dorsal lung regions. Arterial blood gas measurements were taken before and after the intervention. A responder was defined as having an improvement of more than 10% in the oxygenation index after 60 minutes in prone position. Twelve children (nine male, 65%) were studied. Four children were responders, three were nonresponders, and five showed no change to prone positioning. Ventilation in ventral and dorsal lung regions was no different in the supine or prone positions between response groups. The proportion of ventilation in the dorsal lung increased from 49% to 57% in responders, while it became more equal between ventral and dorsal lung regions in the prone position in nonresponders. Responders showed greater improvements in ventilation homogeneity with R improving from 0.86 ± 0.24 to 0.98 ± 0.02 in the ventral lung and 0.91 ± 0.15 to 0.99 ± 0.01 in the dorsal lung region with time in the prone position. The response to prone position was variable in children with acute respiratory distress syndrome. Prone positioning improves homogeneity of ventilation and may result in recruitment of the dorsal lung regions.
En soins intensifs de pediatrie et de neonatologie, evaluer la gravite des extravasations des cat... more En soins intensifs de pediatrie et de neonatologie, evaluer la gravite des extravasations des catheters veineux peripheriques est une difficulte majeure. L’objectif de cette etude etait de montrer l’amelioration de la mesure d’extravasation par les infirmieres avec la mise en place d’un instrument standardise et adapte a l’enfant. 66 infirmieres, randomisees en deux groupes, ont evalue la gravite d’extravasations sur la base de 15 vignettes cliniques. Un groupe controle (n=33) a evalue grâce au jugement clinique, sans instrument, et un groupe intervention (n=33) a evalue avec un instrument standardise, la Pediatric Peripheral Intravenous Infiltration Scale. Des mesures de concordance et de sensibilite ont ete calculees entre les mesures observees et les mesures de reference etablies par un panel d’experts. Les mesures de concordance du groupe intervention κ=0,62 (IC 95 % ; 0,57-0,67) etaient significativement plus elevees que celles du groupe controle κ=0,51 (IC 95 % ; 0,45-0,57), tout comme la sensibilite des mesures du groupe intervention (69 %) comparee a celle du groupe controle (60 %) (p<0,001). Ces resultats soutiennent l’interet d’utiliser un instrument standardise d’evaluation de l’extravasation en clinique. Cette etude realisee sur la base de vignettes cliniques, implique de futures recherches en situation d’extravasations reelles pour confirmer ces resultats.
Acute respiratory distress syndrome (ARDS) is undefined in neonates, despite the long-standing ex... more Acute respiratory distress syndrome (ARDS) is undefined in neonates, despite the long-standing existing formal recognition of ARDS syndrome in later life. We describe the Neonatal ARDS Project: an international, collaborative, multicentre, and multidisciplinary project which aimed to produce an ARDS consensus definition for neonates that is applicable from the perinatal period. The definition was created through discussions between five expert members of the European Society for Paediatric and Neonatal Intensive Care; four experts of the European Society for Paediatric Research; two independent experts from the USA and two from Australia. This Position Paper provides the first consensus definition for neonatal ARDS (called the Montreux definition). We also provide expert consensus that mechanisms causing ARDS in adults and older children-namely complex surfactant dysfunction, lung tissue inflammation, loss of lung volume, increased shunt, and diffuse alveolar damage-are also present...
Background Management of children with necrotizing enterocolitis (NEC) remains challenging. Vario... more Background Management of children with necrotizing enterocolitis (NEC) remains challenging. Various scores try to facilitate therapeutic decision-making. We aim to assess the agreement of three scores intending to predict the need for surgery and/or mortality in our patient cohort, and analyze agreement between the different scores. Methods This study is a retrospective analysis of patients with NEC Bell's stage II and III, managed in a single institution (1991–2011). Three existing scores (Metabolic Derangement Acuity score, NEC score, Detroit score) were calculated individually for each patient. The agreement between predicted outcome by scores and real outcome was evaluated with kappa statistic. Results Of 57 children, 46% presented with NEC stage II, 54% with stage III, 46% were treated with surgery, 54% conservatively, and survival was 58%. The kappa indexes for “need for surgery” were 0.41, 0.13, and 0.12 and kappa indexes for “mortality” were 0.27, 0.04, and 0.1 for the M...
We evaluated the effects of different respiratory assist modes on cerebral blood flow (CBF) and a... more We evaluated the effects of different respiratory assist modes on cerebral blood flow (CBF) and arterial oxygenation in single-ventricle patients after bidirectional superior cavopulmonary anastomosis (BCPA). We hypothesized that preserved auto-regulation of respiration during neurally adjusted ventilatory assist (NAVA) may have potential advantages for CBF and pulmonary blood flow regulation after the BCPA procedure. We enrolled 23 patients scheduled for BCPA, who underwent pressure-controlled ventilation (PCV), pressure support ventilation (PSV), and NAVA at two assist levels for all modes in a randomized order. PCV targeting large V T (15 mL × kg(-1)) resulted in lower CBF and oxygenation compared to targeting low V T (10 mL × kg(-1)). During PSV and NAVA, ventilation assist levels were titrated to reduce EAdi from baseline by 75 % (high assist) and 50 % (low assist). High assist levels during PSV (PSVhigh) were associated with lower PaCO2, PaO2, and O2SAT, lower CBF, and higher ...
Archives of disease in childhood. Fetal and neonatal edition, Jan 8, 2016
To report the population-based, gestational age (GA)-stratified mortality and morbidity for very ... more To report the population-based, gestational age (GA)-stratified mortality and morbidity for very preterm infants over 13 years in Switzerland. A prospective, observational study including 95% of Swiss preterm infants (GA <32 weeks) during three time periods: 2000-2004 (P1), 2005-2008 (P2) and 2009-2012 (P3). The Swiss Neonatal Network, covering all level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals. 8899 live-born preterm infants with GA <32 weeks. Trends in GA-specific mortality (overall, delivery room and NICU), 'survival free of major complications' and major short-term morbidities: bronchopulmonary dysplasia (BPD, oxygen requirement at 36 weeks), grades 3 and 4 intraventricular haemorrhage (IVH 3-4), necrotising enterocolitis (NEC) and cystic periventricular leukomalacia (cPVL). Survival rate was 84.4%; 5.7% died in the delivery room and 9.9% died in the NICU. Neonatal mortality was 8.6% and post-neonatal mortality in NICU admission...
Introduction L’immaturite de la reponse immunitaire du premature est liee a la polarisation Th2 d... more Introduction L’immaturite de la reponse immunitaire du premature est liee a la polarisation Th2 durant la vie fœtale et l’absence d’expression des complexes de reconnaissance innee qui peuvent etre restaures ex vivo par un traitement a l’interferon gamma (IFN-g). Objectif Etudier in vivo l’impact d’un traitement par IFN-g sur la reponse immunitaire du raton nouveau-ne presentant un sepsis a E. coli. Materiels et methodes Vingt-neuf ratons nouveau-nes ont ete traites, par IFN-g ou NaCl 0.9% puis infectes ou non par une souche d’ E. coli. Du sang, de la rate, du foie et du poumon ont ete preleves puis analyses. L’etude du profil transcriptionnel des mediateurs de la reconnaissance et de la signalisation des bacteries a Gram negatif a ete realisee par QPCR. Resultats L’IFN-g a permis de renverser la diminution de l’expression du complexe de reconnaissance endotoxinique (p Conclusions Le traitement par l’IFN-g lors d’un sepsis neonatal a E.coli , permet de restaurer le profil transcriptionnel des complexes de reconnaissance, ameliorant la qualite de la reponse antibacterienne.
To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenatio... more To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenation (ECMO). Among children who have undergone ECMO cardiopulmonary resuscitation (ECPR), the overall rate of survival to discharge is close to 40%. However, despite its wide acceptance and use, the appropriate indications and organizational requirements for ECPR have yet to be defined. Our objective was to assess the clinical outcomes of children after ECPR and to determine pre-ECPR prognostic factors for survival to guide its indication. Among the 19 patients who underwent ECPR between 2008 and 2014 in our center, 16 patients (84%, 95% confidence interval: 62–95%) died during their hospital stay, including nine (47%) who were on ECMO and seven (37%) after successful weaning from ECMO. All three survivors had normal cognitive status, but one child suffered from spastic quadriplegia. Survivors tended to have lower lactate, higher bicarbonate, and higher pH levels before ECMO initiation, as ...
BACKGROUND: User errors in managing heated humidifiers (HHs) have been suggested to be a source o... more BACKGROUND: User errors in managing heated humidifiers (HHs) have been suggested to be a source of nasal burns in newborns treated with nasal CPAP. This study evaluated the risk of burns by reproducing 3 typical errors concerning the use of HHs. METHODS: Six HHs were tested on a bench in a traditional nasal CPAP setup: PMH5000, Aircon (Wilamed); MR730, MR850, MR950 (Fisher & Paykel); and H900 (Hamilton). Temperature was measured at the end of the inspiratory tubing limb. Errors tested were (1) misconnection of the HH thermal probes (NoProbe), (2) absence of gas flow while the HH is on (NoFlow), and (3) unsuitable repeated acknowledgment of the HH alarm (NoAlarm). These errors were combined in 3 standardized scenarios: (1) NoProbe + NoFlow + NoAlarm; (2) NoProbe + NoAlarm, and (3) NoFlow + NoAlarm. The NoProbe + NoFlow + NoAlarm and NoProbe + NoAlarm scenarios were not tested in the H900 and MR950 because the proprietary circuits of these HHs are equipped with embedded probes. RESULT...
Background and Purpose: Cardiac pathologies are the second most frequent risk factor (RF) in chil... more Background and Purpose: Cardiac pathologies are the second most frequent risk factor (RF) in children with arterial ischemic stroke (AIS). This study aimed to analyze RFs for AIS in children with cardiac disease and cardiac intervention. Methods: Data were drawn from the Swiss Neuropediatric Stroke Registry. Patients with cardiac disease and postprocedural AIS registered from 2000 until 2015 were analyzed for the cause of cardiac disease and for potential RFs. Results: Forty-seven out of 78 children with cardiac disease had a cardiac intervention. Of these, 36 presented a postprocedural AIS. Median time from cardiac intervention to symptom onset was 4 days (interquartile range, 2–8.5); time to diagnosis of AIS was 2 days (interquartile range, 0–5.8). Main RFs for postprocedural AIS were hypotension, prosthetic cardiac material, right-to-left shunt, arrhythmias, low cardiac output, and infections. Conclusions: In children with postprocedural AIS, time to diagnosis was delayed. Most p...
Pediatric Index of Mortality (PIM) 2 score is used in pediatric intensive care unit (PICU) to pre... more Pediatric Index of Mortality (PIM) 2 score is used in pediatric intensive care unit (PICU) to predict the patients’ risk of death. The performance of this model has never been assessed in Switzerland. The aim of this study was to evaluate the performance of the PIM2 score in the whole cohort and in pre-specified diagnostic subgroups of patients admitted to PICUs in Switzerland. All children younger than 16 years admitted to any PICU in Switzerland between January 1, 2012 and December 31, 2017 were included in the study. A total of 22,382 patients were analyzed. Observed mortality was 2%, whereas mortality predicted by PIM2 was 4.2% (SMR = 0.47, 95% CI, 0.42–0.52). Calibration was also poor across the deciles of mortality risks (p < 0.001). The AUC-ROC for the entire cohort was 0.88 (95% CI, 0.87–0.90). Calibration varied significantly according to primary diagnosis. Conclusion: The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. The PIM 2 score tends to under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest. What is Known: •PIM2 score is a widely used mortality prediction model in PICU. •PIM2 performance among uncommon but clinically relevant diagnostic subgroups of patients is unknown. •The performance of PIM2 score has never been assessed in Switzerland. What is New: •The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. •Calibration varies significantly according to primary diagnosis. The PIM 2 score under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest. What is Known: •PIM2 score is a widely used mortality prediction model in PICU. •PIM2 performance among uncommon but clinically relevant diagnostic subgroups of patients is unknown. •The performance of PIM2 score has never been assessed in Switzerland. What is New: •The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. •Calibration varies significantly according to primary diagnosis. The PIM 2 score under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest.
To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric int... more To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. Cross-sectional electronic survey. The survey was distributed to the ESPNIC mailing list and to researchers in different European centers. One hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respi...
To determine the effect of prone positioning on ventilation distribution in children with acute r... more To determine the effect of prone positioning on ventilation distribution in children with acute respiratory distress syndrome. Prospective observational study. Paediatric Intensive Care at Red Cross War Memorial Children&amp;amp;amp;amp;#39;s Hospital, Cape Town, South Africa. Mechanically ventilated children with acute respiratory distress syndrome. Electrical impedance tomography measures were taken in the supine position, after which the child was turned into the prone position, and subsequent electrical impedance tomography measurements were taken. Thoracic electrical impedance tomography measures were taken at baseline and after 5, 20, and 60 minutes in the prone position. The proportion of ventilation, regional filling characteristics, and global inhomogeneity index were calculated for the ventral and dorsal lung regions. Arterial blood gas measurements were taken before and after the intervention. A responder was defined as having an improvement of more than 10% in the oxygenation index after 60 minutes in prone position. Twelve children (nine male, 65%) were studied. Four children were responders, three were nonresponders, and five showed no change to prone positioning. Ventilation in ventral and dorsal lung regions was no different in the supine or prone positions between response groups. The proportion of ventilation in the dorsal lung increased from 49% to 57% in responders, while it became more equal between ventral and dorsal lung regions in the prone position in nonresponders. Responders showed greater improvements in ventilation homogeneity with R improving from 0.86 ± 0.24 to 0.98 ± 0.02 in the ventral lung and 0.91 ± 0.15 to 0.99 ± 0.01 in the dorsal lung region with time in the prone position. The response to prone position was variable in children with acute respiratory distress syndrome. Prone positioning improves homogeneity of ventilation and may result in recruitment of the dorsal lung regions.
En soins intensifs de pediatrie et de neonatologie, evaluer la gravite des extravasations des cat... more En soins intensifs de pediatrie et de neonatologie, evaluer la gravite des extravasations des catheters veineux peripheriques est une difficulte majeure. L’objectif de cette etude etait de montrer l’amelioration de la mesure d’extravasation par les infirmieres avec la mise en place d’un instrument standardise et adapte a l’enfant. 66 infirmieres, randomisees en deux groupes, ont evalue la gravite d’extravasations sur la base de 15 vignettes cliniques. Un groupe controle (n=33) a evalue grâce au jugement clinique, sans instrument, et un groupe intervention (n=33) a evalue avec un instrument standardise, la Pediatric Peripheral Intravenous Infiltration Scale. Des mesures de concordance et de sensibilite ont ete calculees entre les mesures observees et les mesures de reference etablies par un panel d’experts. Les mesures de concordance du groupe intervention κ=0,62 (IC 95 % ; 0,57-0,67) etaient significativement plus elevees que celles du groupe controle κ=0,51 (IC 95 % ; 0,45-0,57), tout comme la sensibilite des mesures du groupe intervention (69 %) comparee a celle du groupe controle (60 %) (p<0,001). Ces resultats soutiennent l’interet d’utiliser un instrument standardise d’evaluation de l’extravasation en clinique. Cette etude realisee sur la base de vignettes cliniques, implique de futures recherches en situation d’extravasations reelles pour confirmer ces resultats.
Acute respiratory distress syndrome (ARDS) is undefined in neonates, despite the long-standing ex... more Acute respiratory distress syndrome (ARDS) is undefined in neonates, despite the long-standing existing formal recognition of ARDS syndrome in later life. We describe the Neonatal ARDS Project: an international, collaborative, multicentre, and multidisciplinary project which aimed to produce an ARDS consensus definition for neonates that is applicable from the perinatal period. The definition was created through discussions between five expert members of the European Society for Paediatric and Neonatal Intensive Care; four experts of the European Society for Paediatric Research; two independent experts from the USA and two from Australia. This Position Paper provides the first consensus definition for neonatal ARDS (called the Montreux definition). We also provide expert consensus that mechanisms causing ARDS in adults and older children-namely complex surfactant dysfunction, lung tissue inflammation, loss of lung volume, increased shunt, and diffuse alveolar damage-are also present...
Background Management of children with necrotizing enterocolitis (NEC) remains challenging. Vario... more Background Management of children with necrotizing enterocolitis (NEC) remains challenging. Various scores try to facilitate therapeutic decision-making. We aim to assess the agreement of three scores intending to predict the need for surgery and/or mortality in our patient cohort, and analyze agreement between the different scores. Methods This study is a retrospective analysis of patients with NEC Bell's stage II and III, managed in a single institution (1991–2011). Three existing scores (Metabolic Derangement Acuity score, NEC score, Detroit score) were calculated individually for each patient. The agreement between predicted outcome by scores and real outcome was evaluated with kappa statistic. Results Of 57 children, 46% presented with NEC stage II, 54% with stage III, 46% were treated with surgery, 54% conservatively, and survival was 58%. The kappa indexes for “need for surgery” were 0.41, 0.13, and 0.12 and kappa indexes for “mortality” were 0.27, 0.04, and 0.1 for the M...
We evaluated the effects of different respiratory assist modes on cerebral blood flow (CBF) and a... more We evaluated the effects of different respiratory assist modes on cerebral blood flow (CBF) and arterial oxygenation in single-ventricle patients after bidirectional superior cavopulmonary anastomosis (BCPA). We hypothesized that preserved auto-regulation of respiration during neurally adjusted ventilatory assist (NAVA) may have potential advantages for CBF and pulmonary blood flow regulation after the BCPA procedure. We enrolled 23 patients scheduled for BCPA, who underwent pressure-controlled ventilation (PCV), pressure support ventilation (PSV), and NAVA at two assist levels for all modes in a randomized order. PCV targeting large V T (15 mL × kg(-1)) resulted in lower CBF and oxygenation compared to targeting low V T (10 mL × kg(-1)). During PSV and NAVA, ventilation assist levels were titrated to reduce EAdi from baseline by 75 % (high assist) and 50 % (low assist). High assist levels during PSV (PSVhigh) were associated with lower PaCO2, PaO2, and O2SAT, lower CBF, and higher ...
Archives of disease in childhood. Fetal and neonatal edition, Jan 8, 2016
To report the population-based, gestational age (GA)-stratified mortality and morbidity for very ... more To report the population-based, gestational age (GA)-stratified mortality and morbidity for very preterm infants over 13 years in Switzerland. A prospective, observational study including 95% of Swiss preterm infants (GA <32 weeks) during three time periods: 2000-2004 (P1), 2005-2008 (P2) and 2009-2012 (P3). The Swiss Neonatal Network, covering all level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals. 8899 live-born preterm infants with GA <32 weeks. Trends in GA-specific mortality (overall, delivery room and NICU), 'survival free of major complications' and major short-term morbidities: bronchopulmonary dysplasia (BPD, oxygen requirement at 36 weeks), grades 3 and 4 intraventricular haemorrhage (IVH 3-4), necrotising enterocolitis (NEC) and cystic periventricular leukomalacia (cPVL). Survival rate was 84.4%; 5.7% died in the delivery room and 9.9% died in the NICU. Neonatal mortality was 8.6% and post-neonatal mortality in NICU admission...
Introduction L’immaturite de la reponse immunitaire du premature est liee a la polarisation Th2 d... more Introduction L’immaturite de la reponse immunitaire du premature est liee a la polarisation Th2 durant la vie fœtale et l’absence d’expression des complexes de reconnaissance innee qui peuvent etre restaures ex vivo par un traitement a l’interferon gamma (IFN-g). Objectif Etudier in vivo l’impact d’un traitement par IFN-g sur la reponse immunitaire du raton nouveau-ne presentant un sepsis a E. coli. Materiels et methodes Vingt-neuf ratons nouveau-nes ont ete traites, par IFN-g ou NaCl 0.9% puis infectes ou non par une souche d’ E. coli. Du sang, de la rate, du foie et du poumon ont ete preleves puis analyses. L’etude du profil transcriptionnel des mediateurs de la reconnaissance et de la signalisation des bacteries a Gram negatif a ete realisee par QPCR. Resultats L’IFN-g a permis de renverser la diminution de l’expression du complexe de reconnaissance endotoxinique (p Conclusions Le traitement par l’IFN-g lors d’un sepsis neonatal a E.coli , permet de restaurer le profil transcriptionnel des complexes de reconnaissance, ameliorant la qualite de la reponse antibacterienne.
To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenatio... more To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenation (ECMO). Among children who have undergone ECMO cardiopulmonary resuscitation (ECPR), the overall rate of survival to discharge is close to 40%. However, despite its wide acceptance and use, the appropriate indications and organizational requirements for ECPR have yet to be defined. Our objective was to assess the clinical outcomes of children after ECPR and to determine pre-ECPR prognostic factors for survival to guide its indication. Among the 19 patients who underwent ECPR between 2008 and 2014 in our center, 16 patients (84%, 95% confidence interval: 62–95%) died during their hospital stay, including nine (47%) who were on ECMO and seven (37%) after successful weaning from ECMO. All three survivors had normal cognitive status, but one child suffered from spastic quadriplegia. Survivors tended to have lower lactate, higher bicarbonate, and higher pH levels before ECMO initiation, as ...
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