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Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge

Pulse oximetry (PO) screening is used to screen newborns for critical congenital heart defects (CCHD). Analyses performed in hospital settings suggest that PO screening is cost-effective. We assessed the costs and cost-effectiveness of PO screening in the Dutch perinatal care setting, with home births and early postnatal discharge, compared to a situation without PO screening...

The effect of breathing on ductus arteriosus blood flow directly after birth

Spontaneous breathing at birth influences ductus arteriosus (DA) flow. This study quantifies the effect of breathing on DA shunting directly after birth. In healthy term infants born by elective cesarean section, simultaneous measurements of DA shunting and tidal volumes during spontaneous breathing were performed at 2–5, 5–8, and 10–13 min after birth. Eight infants with a mean...

Maternal acceptability of pulse oximetry screening at home after home birth or very early discharge

The Netherlands has a unique perinatal healthcare system with a high rate of home births and very early discharge after delivery in hospital. Although we demonstrated that pulse oximetry (PO) screening for critical congenital heart disease is feasible in the Netherlands, it is unknown whether parents find the screening acceptable when performed in home birth setting. We assessed...

Hypothermia in Preterm Infants in the First Hours after Birth: Occurrence, Course and Risk Factors

Background Hypothermia is associated with increased morbidity and mortality rates. Preterm infants frequently have hypothermia when they are admitted to the NICU, but there is no data on the occurrence of hypothermia during the first hours after admission. Objective To investigate the occurrence of hypothermia in preterm infants in the first three hours of admission and to...

Improving manual oxygen titration in preterm infants by training and guideline implementation

To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85–95%) was calculated (%SpO2-wtr). SpO2 was collected every minute...

Reliability of Single-Use PEEP-Valves Attached to Self-Inflating Bags during Manual Ventilation of Neonates – An In Vitro Study

Introduction International resuscitation guidelines suggest to use positive end-expiratory pressure (PEEP) during manual ventilation of neonates. Aim of our study was to test the reliability of self-inflating bags (SIB) with single-use PEEP valves regarding PEEP delivery and the effect of different peak inflation pressures (PIP) and ventilation rates (VR) on the delivered PEEP...

Accuracy of currently available neonatal respiratory function monitors for neonatal resuscitation

University Medical Centre , Albinusdreef 2, 2333ZA Leiden , The Netherlands 1 Arjan B. te Pas 2 Communicated by Patrick Van Reempts 3 MIMR-PHI Institute for Medical Research, Monash University , Clayton

Lung hypoplasia in newborn rabbits with a diaphragmatic hernia affects pulmonary ventilation but not perfusion

6 Lauren Kerr 4 5 Charles C. Roehr 4 Andreas Fouras 7 Richard Carnibella 6 Jaccques C. Jani 8 Philip DeKoninck 4 5 Arjan B. te Pas 9 James T. Pearson 0 10 Stuart B. Hooper 4 5 0 Australian

Very Preterm Infants Failing CPAP Show Signs of Fatigue Immediately after Birth

Objective To investigate the differences in breathing pattern and effort in infants at birth who failed or succeeded on continuous positive airway pressure (CPAP) during the first 48 hours after birth. Methods Respiratory function recordings of 32 preterm infants were reviewed of which 15 infants with a gestational age of 28.6 (0.7) weeks failed CPAP and 17 infants with a GA of...

The perfusion index of healthy term infants during transition at birth

Department of Pediatrics, Division of Neonatology, Leiden University Medical Center , J6-S, PO Box 9600, 2300 RC Leiden , The Netherlands 5 Arjan B. te Pas Perfusion index is a continuous parameter provided ... , and approved the final manuscript as submitted. Arjan B. te Pas conceptualized and designed the study, supervised the data collection, reviewed, and revised the manuscript, and approved the final

Compliance in oxygen saturation targeting in preterm infants: a systematic review

During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance...

Optimizing lung aeration at birth using a sustained inflation and positive pressure ventilation in preterm rabbits

AuthorsSearch for Arjan B. te Pas in:Nature Research journals • PubMed • Google ScholarSearch for Marcus J. Kitchen in:Nature Research journals • PubMed • Google ScholarSearch for Katie Lee in:Nature Research ... • PubMed • Google ScholarSearch for Stuart B. Hooper in:Nature Research journals • PubMed • Google Scholar Corresponding author Correspondence to Arjan B. te Pas. Supplementary information Zip files1

Two-Minute Training for Improving Neonatal Bag and Mask Ventilation

B. te Pas 0 1 Edgardo Szyld, Icahn School of Medicine at Mount Sinai, Argentina 0 The Neonatal Intensive Care Unit (NICU) of the Leiden University Medical Centre is a tertiary level perinatal center

Cardiovascular transition at birth: a physiological sequence

ScholarSearch for Arjan B. te Pas in:Nature Research journals • PubMed • Google ScholarSearch for Justin Lang in:Nature Research journals • PubMed • Google ScholarSearch for Jeroen J. van Vonderen in:Nature ...  & Arjan B. te Pas Maternal Health, Neonatology and Perinatology (2016) Erstversorgung von Früh- und Termingeborenen M. Rüdiger & D. Konstantelos Monatsschrift Kinderheilkunde (2016

Do We Deliver the Pressures We Intend to When Using a T-Piece Resuscitator?

Background A T-piece resuscitator (TPR) uses a built-in manometer to set the inflation pressures, but we are not informed what pressures are actually delivered distally. Aim of this study was to measure the proximal and distal pressures under different gas conditions when using a TPR. Methodology/Findings A test lung was ventilated using a TPR (PIP 25 cmH2O, PEEP 5 cmH2O) with a...

Ventilation Onset Prior to Umbilical Cord Clamping (Physiological-Based Cord Clamping) Improves Systemic and Cerebral Oxygenation in Preterm Lambs

Background As measurement of arterial oxygen saturation (SpO2) is common in the delivery room, target SpO2 ranges allow clinicians to titrate oxygen therapy for preterm infants in order to achieve saturation levels similar to those seen in normal term infants in the first minutes of life. However, the influence of the onset of ventilation and the timing of cord clamping on...

Changes in Positive End-Expiratory Pressure Alter the Distribution of Ventilation within the Lung Immediately after Birth in Newborn Rabbits

Current recommendations suggest the use of positive end-expiratory pressures (PEEP) to assist very preterm infants to develop a functional residual capacity (FRC) and establish gas exchange at birth. However, maintaining a consistent PEEP is difficult and so the lungs are exposed to changing distending pressures after birth, which can affect respiratory function. Our aim was to...

The Administration of 100% Oxygen and Respiratory Drive in Very Preterm Infants at Birth

Aim To retrospectively investigate the changes of SpO2 and respiratory drive in preterm infants at birth after administration of 100% oxygen. Methods Respiratory parameters, FiO2 and oximetry of infants <32 weeks gestation before and after receiving FiO2 1.0 were reviewed during continuous positive airway pressure (CPAP) or positive pressure ventilation (PPV). Results Results are...

Noninvasive measurements of hemodynamic transition directly after birth

. Hooper 0 Arjan Bte Pas 2 0 The Ritchie Centre, Monash Institute for Medical Research, Monash University , Clayton, Victoria , Australia 1 Division of Pediatric Cardiology, Department of Pediatrics

Expired CO2 Levels Indicate Degree of Lung Aeration at Birth

As neonatal resuscitation critically depends upon lung aeration at birth, knowledge of the progression of this process is required to guide ongoing care. We investigated whether expired CO2 (ECO2) levels indicate the degree of lung aeration immediately after birth in two animal models and in preterm infants. Lambs were delivered by caesarean section and ventilated from birth. In...