Cover: Schematic illustration of robustness analysis. The histograms indicate the variations in i... more Cover: Schematic illustration of robustness analysis. The histograms indicate the variations in input parameter ݔ and the output parameter ݂ respectively. The front cover picture is reproduced by courtesy of Volvo Car Corporation and illustrates a side impact simulation.
The Annals of The Royal College of Surgeons of England, 2016
Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units a... more Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. Methods Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006–2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between...
Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified ... more Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Objective Our objective was to determine whether NAVA/NIV-NAVA has advantages in infants with evolving/established bronchopulmonary dysplasia (BPD). Methods Each infant who received NAVA/NIV-NAVA and conventional invasive and NIV was matched with two historical controls. Eighteen NAVA/NIV-NAVA infants’ median gestational age, 25.3 (23.6–28.1) weeks, was compared with 36 historical controls’ median gestational age 25.2 (23.1–29.1) weeks. Results Infants on NAVA/NIV-NAVA had lower extubation failure rates (median: 0 [0–2] vs. 1 [0–6] p = 0.002), shorter durations of invasive ventilation (median: 30.5, [1–90] vs. 40.5 [11–199] days, p = 0.046), and total duration of invasive and NIV to the point of discharge to the local ho...
A premature neonate who developed respiratory distress in the first few days of life was found to... more A premature neonate who developed respiratory distress in the first few days of life was found to have a pleural effusion, which reaccumulated following drainage. The effusion was demonstrated to be a chylothorax. He required multiple chest drains and was started on a medium chain triglyceride formula feed. This brought about a full resolution of the effusions and he made a complete recovery.
To determine whether NAVA compared to other forms of triggered ventilation results in reduced rat... more To determine whether NAVA compared to other forms of triggered ventilation results in reduced rates of BPD or death in newborn infants, either used as a primary or rescue mode of ventilation. To assess the safety of NAVA by determining if there is a greater risk of episodes of hypocarbia or hypercarbia, intraventricular haemorrhage, periventricular leukomalacia, or air leaks compared to other forms of triggered ventilation. Secondary objectives will be to determine whether any benefits differ by gestational age (term or preterm). In crossover trials, outcomes include peak pressure requirements, oxygenation index and the work of breathing.
Background Less invasive surfactant administration (LISA) is the preferred mode of surfactant adm... more Background Less invasive surfactant administration (LISA) is the preferred mode of surfactant administration for spontaneously breathing preterm babies supported by noninvasive ventilation (NIV). Objective The aim of this study was to determine whether LISA on the neonatal unit or in the delivery suite was associated with reduced rates of bronchopulmonary dysplasia (BPD) or the need for intubation, or lower durations of invasive ventilation and length of hospital stay (LOS). Methods A historical comparison was undertaken. Each “LISA” infant was matched with two infants (controls) who did not receive LISA. Results The 25 LISA infants had similar gestational ages and birth weights to the 50 controls (28 [25.6–31.7] weeks vs. 28.5 [25.4–31.9] weeks, p = 0.732; 1,120 (580–1,810) g vs. 1,070 [540–1,869] g, p = 0.928), respectively. LISA infants had lower requirement for intubation (52 vs. 90%, p
Objectives To compare the adjusted and unadjusted-for-weight tidal volume (VT) in ventilated prem... more Objectives To compare the adjusted and unadjusted-for-weight tidal volume (VT) in ventilated prematurely born infants who were successfully extubated compared with the ones who failed extubation and explore the ability of VT to predict successful extubation. Study Design This is a two-center, prospective, observational, cohort study of ventilated infants born <32 weeks of gestational age (GA) at King's College Hospital and St George's University Hospital, London, United Kingdom between February and September 2018. Expiratory VT was recorded before extubation, and extubation was considered successful if the infants were not reintubated within 72 hours. Results Fifty-six (29 male) infants with a median (interquartile range) GA of 26 (25–29) weeks were studied. The infants who successfully extubated (N = 36) had a higher GA (27 [25–30] weeks) and VT (7.2 [4.8–9.5] mL) compared with the GA (25 [24–26] weeks) and VT (4.3 [4.0–5.5] mL) of the infants who failed extubation (p = ...
Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonata... more Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonatal respiratory support.
Some studies of infants with acute respiratory distress have demonstrated that neurally adjusted ... more Some studies of infants with acute respiratory distress have demonstrated that neurally adjusted ventilator assist (NAVA) had better short-term results compared to non-triggered or other triggered models. We determined if very prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD) had a lower oxygenation index (OI) on NAVA compared to assist control ventilation (ACV). Infants were studied for 1 h each on each mode. At the end of each hour, blood gas analysis was performed and the OI calculated. The inspired oxygen concentration (FiO2), the peak inflation (PIP) and mean airway pressures (MAP) and compliance were averaged from the last 5 min on each mode. Nine infants, median gestational age of 25 (range 22-27) weeks, were studied at a median postnatal age of 20 (range 8-84) days. The mean OI after 1 h on NAVA was 7.9 compared to 11.1 on ACV (p = 0.0007). The FiO2 (0.36 versus 0.45, p = 0.007), PIP (16.7 versus 20.1 cm H2O, p = 0.017) and MAP (9.2 versu...
Archives of disease in childhood. Fetal and neonatal edition, Jan 12, 2016
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
Cover: Schematic illustration of robustness analysis. The histograms indicate the variations in i... more Cover: Schematic illustration of robustness analysis. The histograms indicate the variations in input parameter ݔ and the output parameter ݂ respectively. The front cover picture is reproduced by courtesy of Volvo Car Corporation and illustrates a side impact simulation.
The Annals of The Royal College of Surgeons of England, 2016
Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units a... more Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. Methods Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006–2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between...
Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified ... more Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Objective Our objective was to determine whether NAVA/NIV-NAVA has advantages in infants with evolving/established bronchopulmonary dysplasia (BPD). Methods Each infant who received NAVA/NIV-NAVA and conventional invasive and NIV was matched with two historical controls. Eighteen NAVA/NIV-NAVA infants’ median gestational age, 25.3 (23.6–28.1) weeks, was compared with 36 historical controls’ median gestational age 25.2 (23.1–29.1) weeks. Results Infants on NAVA/NIV-NAVA had lower extubation failure rates (median: 0 [0–2] vs. 1 [0–6] p = 0.002), shorter durations of invasive ventilation (median: 30.5, [1–90] vs. 40.5 [11–199] days, p = 0.046), and total duration of invasive and NIV to the point of discharge to the local ho...
A premature neonate who developed respiratory distress in the first few days of life was found to... more A premature neonate who developed respiratory distress in the first few days of life was found to have a pleural effusion, which reaccumulated following drainage. The effusion was demonstrated to be a chylothorax. He required multiple chest drains and was started on a medium chain triglyceride formula feed. This brought about a full resolution of the effusions and he made a complete recovery.
To determine whether NAVA compared to other forms of triggered ventilation results in reduced rat... more To determine whether NAVA compared to other forms of triggered ventilation results in reduced rates of BPD or death in newborn infants, either used as a primary or rescue mode of ventilation. To assess the safety of NAVA by determining if there is a greater risk of episodes of hypocarbia or hypercarbia, intraventricular haemorrhage, periventricular leukomalacia, or air leaks compared to other forms of triggered ventilation. Secondary objectives will be to determine whether any benefits differ by gestational age (term or preterm). In crossover trials, outcomes include peak pressure requirements, oxygenation index and the work of breathing.
Background Less invasive surfactant administration (LISA) is the preferred mode of surfactant adm... more Background Less invasive surfactant administration (LISA) is the preferred mode of surfactant administration for spontaneously breathing preterm babies supported by noninvasive ventilation (NIV). Objective The aim of this study was to determine whether LISA on the neonatal unit or in the delivery suite was associated with reduced rates of bronchopulmonary dysplasia (BPD) or the need for intubation, or lower durations of invasive ventilation and length of hospital stay (LOS). Methods A historical comparison was undertaken. Each “LISA” infant was matched with two infants (controls) who did not receive LISA. Results The 25 LISA infants had similar gestational ages and birth weights to the 50 controls (28 [25.6–31.7] weeks vs. 28.5 [25.4–31.9] weeks, p = 0.732; 1,120 (580–1,810) g vs. 1,070 [540–1,869] g, p = 0.928), respectively. LISA infants had lower requirement for intubation (52 vs. 90%, p
Objectives To compare the adjusted and unadjusted-for-weight tidal volume (VT) in ventilated prem... more Objectives To compare the adjusted and unadjusted-for-weight tidal volume (VT) in ventilated prematurely born infants who were successfully extubated compared with the ones who failed extubation and explore the ability of VT to predict successful extubation. Study Design This is a two-center, prospective, observational, cohort study of ventilated infants born <32 weeks of gestational age (GA) at King's College Hospital and St George's University Hospital, London, United Kingdom between February and September 2018. Expiratory VT was recorded before extubation, and extubation was considered successful if the infants were not reintubated within 72 hours. Results Fifty-six (29 male) infants with a median (interquartile range) GA of 26 (25–29) weeks were studied. The infants who successfully extubated (N = 36) had a higher GA (27 [25–30] weeks) and VT (7.2 [4.8–9.5] mL) compared with the GA (25 [24–26] weeks) and VT (4.3 [4.0–5.5] mL) of the infants who failed extubation (p = ...
Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonata... more Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonatal respiratory support.
Some studies of infants with acute respiratory distress have demonstrated that neurally adjusted ... more Some studies of infants with acute respiratory distress have demonstrated that neurally adjusted ventilator assist (NAVA) had better short-term results compared to non-triggered or other triggered models. We determined if very prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD) had a lower oxygenation index (OI) on NAVA compared to assist control ventilation (ACV). Infants were studied for 1 h each on each mode. At the end of each hour, blood gas analysis was performed and the OI calculated. The inspired oxygen concentration (FiO2), the peak inflation (PIP) and mean airway pressures (MAP) and compliance were averaged from the last 5 min on each mode. Nine infants, median gestational age of 25 (range 22-27) weeks, were studied at a median postnatal age of 20 (range 8-84) days. The mean OI after 1 h on NAVA was 7.9 compared to 11.1 on ACV (p = 0.0007). The FiO2 (0.36 versus 0.45, p = 0.007), PIP (16.7 versus 20.1 cm H2O, p = 0.017) and MAP (9.2 versu...
Archives of disease in childhood. Fetal and neonatal edition, Jan 12, 2016
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
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