Abstracts
7
Table 1
Outcomes
NIHFV
n = 14
BP-CPAP
n = 16
NIV Failure, n (%)
6 (42.9)
10 (62.5)
0.28*
EMV 72 h post
randomization, n (%)
5 (35.7)
5 (31.2)
1.00†
EMV 7 days post
randomization, n (%)
6 (42.9)
6 (37.5)
0.77*
10/12 (83.3)
14 (87.5)
1.00†
BPD, n (%)
P value
*Chi-square test; †Fisher’s Exact test
6
TOWARDS PULSE OXIMETRY SCREENING IN ONTARIO,
CANADA: WHAT IS THE BURDEN OF MISSED CRITICAL
CONGENITAL HEART DISEASE?
A Mukerji*, V Shah, M Kumar, M Geraghty, A Guttmann, E Cohen,
A Jain
Hamilton, Ontario
BACKGROUND: Pulse oximetry screening (POS) for critical congenital heart disease (CCHD) in newborns is gaining acceptance in clinical
practice. The geographical setting of Ontario in relation to its vast yet
sparsely populated regions presents unique challenges with regards to
POS implementation.
OBJECTIVES: Evaluate the incidence of missed CCHD cases and the
trends over time in Ontario, Canada over 10 years as a first step towards
consideration of POS.
DESIGN/METHODS: Data from multiple, linked, administrative health
and demographic datasets were used to determine the annual incidence of
total and missed cases of CCHD in Ontario from 2002-11, along with baseline demographics including designated level of birth hospital. Patients discharged home prior to diagnosis of CCHD were considered to have “missed
CCHD” and were further subcategorized into “definitely missed” [1 of 9 predetermined severest CCHDs and re-admission within 30 days or death] and
“possibly missed” [1 of 6 less severe CCHDs requiring readmission in first
year of life resulting in either cardiac intervention or death]. Annual trends
in incidence of missed CCHD were evaluated during study period.
RESULTS: Of 1,343,850 total births in Ontario during the study period,
2787 (0.21%) had a diagnosis of CCHD and 438 (15.7%) cases of CCHD
were missed. Of these 438 patients, 66 were definitely and 372 were possibly missed CCHD cases and the proportion delivered in hospitals without
neonatal intensive care capability was 77.3% and 82.5%, respectively.
There was no discernible change in the incidence of missed CCHD cases
over the ten year period.
CONCLUSION: Despite a low overall incidence of CCHD, a significant
proportion of CCHD cases were not diagnosed prior to discharge home,
and the vast majority were delivered in non-tertiary hospitals. Further
research is required to evaluate the logistical and economic impact of POS
implementation in Ontario in light of these data.
NEONATAL ENDOTRACHEAL INTUBATION LEARNED WITH
VIDEOLARYNGOSCOPE IS MAINTAINED WITH CLASSIC
LARYNGOSCOPE: PHASE 2 OF A CROSSOVER
RANDOMIZED TRIAL
A Moussa*, Y Luangxay, S Tremblay, J Lavoie, G Aube, E Savoie,
C Lachance
CHU Ste-Justine, Montreal, Quebec
BACKGROUND: Between July 2011 and June 2013, 34 pediatric residents were randomized to perform 213 endotracheal intubations (ETI)
using either the videolaryngoscope (VL) or the classic laryngoscope (CL)
in the Neonatal Intensive Care Unit (NICU) at CHU Ste-Justine. Success
rate of ETI was improved in residents learning with the VL (75.2 vs
63.4%). It is unknown if the ETI skill learned from the VL is maintained
when residents switch to the CL.
OBJECTIVES: Assess if the ETI skill acquired from the VL is transferable
to the CL in the NICU.
DESIGN/METHODS: Phase 2 of the randomized controlled trial was
held between January 2012 and December 2013. Primary outcome: Success
rate and learning curve (Generalized estimating equations). Secondary
outcomes: a) Time to successful intubation (Mann-Whitney Test); b)
Comparison of success rates between both phases of the study for each
group (χ2 test).
RESULTS: Twenty-three of the 34 randomized residents completed
phase 2 of the study and performed 55 ETI using the CL. In both groups,
prior training, experience in the NICU and with neonatal ETI were similar. Patient characteristics, success rate and time to successful intubation
are presented in the table. In phase 2, learning curve of the CL group
remained stable at 80% success rate with ongoing intubations while it
decreased slightly but not significantly to 75% for the VL group. Success
rates in phase 1 and phase 2 of VL group (75.2 vs 62.5%, P=0.16) and CL
group (63.4 vs 77.4%, P=0.10) did not differ.
CONCLUSION: Residents improved success rate of ETI with the VL
slightly decreases, but not significantly, when switched to the CL. Time to
successful intubation is also similar in both groups. This suggests that the
acquired skill from the VL is maintained with the CL. The VL is a promising tool for teaching ETI as residents reach higher success rates more rapidly and the acquired skill is transferable to the CL.
VL group
n=24
CL group
n=31
29 2/7
27 2/7
0.94
1135
1090
1.00
Median age at ETI, weeks
31 1/7
31 1/7
0.39
Median weight at ETI, g
1200
1200
0.27
11 (48)
16 (52)
0.50
15 (62.5)
24 (77.4)
0.49
56,5
43
1.00
P
Patient characteristics
Median gestational age, weeks
Median birth weight, g
Male, n (%)
Success Rate, n (%)
Median time to successful intubation, s
8
TIDAL VOLUME DELIVERY DURING MASK VENTILATION
AND BRAIN INJURY IN NEWBORNS <29 WEEKS
GESTATION
G Schmolzer*, Q Mian, PY Cheung, M O’Reilly, G Polglase, K Aziz
Edmonton, Alberta
BACKGROUND: Delivery of inadvertent high tidal volume (VT) during
positive pressure ventilation (PPV) in the delivery room is common and
associated with hemodynamic brain injury in animal models.
OBJECTIVES: To examine if high VT delivery during PPV at birth
causes brain injury in preterm infants <29 weeks gestation.
DESIGN/METHODS: A flow-sensor was placed between the mask and
the ventilation device. VT values were compared with recently described
reference ranges for VT in spontaneously breathing preterm infants at
birth. Infants were divided into two groups: VT < or >5.8 mL/kg (normal
and high VT, respectively). Brain injury (eg, intraventricular hemorrhage
Paediatr Child Health Vol 20 No 5 June/July 2015
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