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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 150 (1991), S. 732-734 
    ISSN: 1432-1076
    Keywords: Patient triggered ventilation ; Chronic lung disease ; Preterm infants
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patient triggered ventilation (PTV) has been assessed as a method of respiratory support in infants remaining ventilator-dependent beyond the 1st week of life. Sixteen preterm infants were studied who had a median gestational age of 26 weeks and postnatal age of 22 days. PTV was delivered using a ventilator incorporating an airway pressure trigger. PTV was only successfully maintained until extubation in 3 infants, failing to provide a satisfactory method of respiratory support in the remaining 13 infants after a median of 1 h (range 1–10). One of the 13 infants was persistently asynchronous at 1 h despite manipulation of inflation time. The other 12 infants, at failure of PTV, were making respiratory efforts which were inadequate to consistently trigger the ventilator. Infants in whom PTV was successful were older, more mature and of greater birth weight; the trigger delay at 1 h was significantly shorter in this group (P〈0.05). A predictor of failure of PTV was asynchrony in the 1st h after commencing PTV (P〈0.02). We conclude PTV incorporating an airway pressure trigger infrequently provides a useful method of respiratory support in infants who are chronically ventilator-dependent.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 151 (1992), S. 134-135 
    ISSN: 1432-1076
    Keywords: Hypertension ; Chronic lung disease ; Dexamethosone ; Preterm delivery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The magnitude and duration of the effect of dexamethasone on systolic blood pressure has been examined in 13 very preterm infants (median gestational age 25 weeks). All had chronic lung disease (CLD). To exclude any effect of CLD on blood pressure each infant acted as his or her own control. Systolic blood pressure increased in all infants (P〈0.01) and remained elevated for at least 48h following cessation of therapy. The median maximum increase in blood pressure was 24 mm Hg (range 13–49 mmHg) and occurred on day 4 (median, range 2–10) of treatment. One infant developed hypertensive encephalopathy. These results demonstrate the need to monitor infants with CLD throughout steroid therapy and preferably for some days after it has ceased.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 150 (1991), S. 440-443 
    ISSN: 1432-1076
    Keywords: Neonatal ventilation ; Preterm ; Synchrony ; Minute volume
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The importance of the preterm infant's inspiratory time in determining the optimum inflation time during mechanical ventilation was investigated. The optimum inflation time was defined as that which was most commonly associated with synchronous respiration and maximum minute volume. Twelve preterm infants were studied on 14 occasions. They were ventilated at rates of 60, 75, 90, 105 and 120 breaths/min, with an inspiratory: expiratory ratio of 1∶1.2. These rates were chosen as they resulted in inflation times approximating to the spontaneous inspiratory time measured during a brief period of disconnection, on continuous positive airways pressure (CPAP), and greater than that measured on CPAP. Inspiratory time during disconnection was always shorter than that measured on CPAP (P〈0.01). Synchrony was most commonly provoked and minute volume greatest at the shortest inflation time (P〈0.01). We conclude fast ventilator rates are most efficacious for preterm neonates. As previously shown, this rate can be estimated by examining the standard reference range of rates in relation to gestational age.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1076
    Keywords: Pulmonary hypoplasia ; Functional residual capacity ; Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Serial measurements of functional residual capacity (FRC) were made in 22 infants (median gestational age at delivery 32 weeks, range 25–40) during the first 2 years of life. All infants had been delivered from pregnancies complicated by prolonged and preterm rupture of the membranes (PPROM) of at least 1 week in duration. The onset of membrane rupture was at a median of 26 weeks (range 15–32) with a median duration of 5.5 weeks (range 1–21). The mean FRC at all postnatal ages studied: 25 ml/kg at 6 and 12 months and 24ml/kg at 18 and 24 months did not differ significantly from the control population (mean 24ml/kg). There was, however, a wider scatter of results in the study population: four infants born very preterm consistently had FRC results above the 95% confidence limits of the controls but only two infants had FRCs consistently below this range. These results suggest PPROM may not be an invariable association of abnormal antenatal lung growth.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 151 (1992), S. 842-845 
    ISSN: 1432-1076
    Keywords: Patient triggered ventilation ; Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The performance of two triggering systems was compared during patient triggered ventilation (PTV) of infants ventilator-dependent beyond 10 days of age. Ten infants were studied who had a median gestational age of 26.5 weeks and a postnatal age of 15.5 days. PTV was administered via the SLE ventilator and the two triggering systems, an airway pressure monitor and the MR10 respiration monitor, were used in random order each for 30 min. The airway pressure trigger had a superior performance in that, although it did not differ significantly in delivered inflation volume or sensitivity to the MR10 respiration monitor, it had a shorter trigger delay (P〈0.01). Oxygenation improved in eight of the ten infants on the airway pressure trigger, but only in three on the MR10 respiration monitor. The reduction in PaCO2 was greater during PTV with the airway pressure trigger compared with the MR10 respiration monitor (P〈0.01). We conclude that the airway pressure trigger has a superior performance compared to the MR10 respiration monitor trigger in infants who are ventilator-dependent beyond 10 days of age.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 152 (1993), S. 350-353 
    ISSN: 1432-1076
    Keywords: High frequency oscillation ; Mean airway pressure ; Oxygenation ; Respiratory distress
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Two studies are reported in which the aim was to assesses whether oxygenation on transfer to or during high frequency oscillation (HFO) was influenced by the mean airway pressure (MAP) level. Sixteen infants, median gestational age 28 weeks, were recruited into the first study and 14 with a median gestational age of 29 weeks into the second. In the initial study, blood gases were measured immediately before and 30 min after transfer to HFO and comparison made of those infants in whom oxygenation did or did not improve. In the second study the infants were studied at two MAP levels, 2 and 5 cmH2O, above that used during conventional ventilation (baseline MAP) and at two frequencies (10 and 15 Hz), arterial blood gases were measured after 20 min on each setting. In the initial study, on transfer to HFO, oxygenation improved by a median of 21 mmHg in eight infants, but was either unchanged or deteriorated (n=7) in the other eight infants, the median impairment in oxygenation was by 17 mm Hg. The infants in whom oxygenation improved had required a significantly higher MAP during conventional ventilation than the rest of the study group. In the second study, increasing the MAP from 2 to 5 cmH2O above baseline resulted in a significant increase in oxygenation, which was significantly greater at 10 rather than 15 Hz. Infants whose MAP remained below 13 cmH2O had impaired oxygenation during HFO compared to that experienced during conventional ventilation. The results of these two studies demonstrate that the MAP level during HFO is an important determinant of oxygenation.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 152 (1993), S. 516-518 
    ISSN: 1432-1076
    Keywords: Blood pressure ; Chronic lung disease ; Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thirteen preterm infants (median gestational age 28 weeks) who had developed neonatal chronic lung disease (CLD) and 13 gender- and gestational agematched controls (without CLD) were prospectively followed. The infants were seen at monthly intervals for 6 months. At each attendance the infants were examined and their blood pressure (BP) measured using a noninvasive Doppler technique. No infant developed symptoms related to hypertension and there were no significant differences in their BP levels at follow up. Our results suggests significant BP elevation is uncommon following neonatal CLD.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 154 (1995), S. 164-165 
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 156 (1997), S. 139-141 
    ISSN: 1432-1076
    Keywords: Key words Blood transfusion  ;  Oxygenation  ;   Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of blood transfusion to maintain a preset packed cell volume (PCV) level in preterm ventilated infants has been investigated. Fifty infants, median gestational age 26 (range 23–33) weeks and postnatal age 4 (1–29) days, transfused a median of 15 ml/kg of blood in response to a PCV ≤ 40% were retrospectively identified and their medical records reviewed to determine the change in PCV and haemoglobin resulting from the transfusions. In addition, their mean airway pressure (MAP) was noted and, as an index of oxygenation, their oxygenation index (OI), alveolar/arterial oxygen gradient (AaDO2) and arterial/alveolar (a/A) ratio calculated 12 h, 6 h and immediately prior to the transfusion and immediately post, 12, 18 and 24 h after the transfusion. The transfusion improved the PCV and haemoglobin (P 〈 0.0001). No significant changes in MAP or level of oxygenation were experienced in the 12 h prior to the transfusion. Post transfusion, despite no significant change in MAP, the AaDO2 OI and a/A ratios compared to immediately prior to the transfusion were significantly better at 12, 18 and 24 h. Conclusion It is useful to transfuse ventilated preterm infants to maintain their PCV above a preset level.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 156 (1997), S. 148-151 
    ISSN: 1432-1076
    Keywords: Key words Chronic lung disease ; Functional residual capacity ; Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Lung function abnormalities, including hyperinflation, are common in young children born prematurely. The aim of this study was, in such patients, to determine factors associated with hyperinflation, that is an elevated lung volume. Lung volume was estimated by measuring functional residual capacity (FRC) before and after bronchodilator therapy in 41 5-year-old children who had been born prematurely at a median of 30 weeks gestational age. Hyperinflation was defined as an FRC greater than 120% of that predicted for height and a positive bronchodilator response as a greater than or equal to 10% change in FRC. Twelve (29%) of the children were symptomatic at 5 years, their median FRC (132%) was significantly higher than that of the asymptomatic children (109%), P 〈 0.01. Twelve (29%) children were hyperinflated; a greater proportion of the hyperinflated compared to the non-hyperinflated patients were symptomatic at 5 years (7 or 58% versus 5 or 17%) (P 〈 0.05) and responded to bronchodilator therapy (9 or 75% versus 4 or 14%) (P 〈 0.01). Regression analysis demonstrated that hyperinflation related significantly only to current symptom status, but not perinatal variables. Conclusion Hyperinflation in young children born prematurely reflects current symptom status and not adverse neonatal events.
    Type of Medium: Electronic Resource
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