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"Neonatology"
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Strukturelle thalamo-kortikale Konnektivitatsveranderungen sind bei fruhgeborenen Erwachsenen mit kognitiven Beeintrachtigungen assoziiert
Hintergrund: Fruhgeburt ist ein risikofaktor fur die Entwicklung psychiatrischer Erkrankungen und kognitiver beeintrachtigung. Dies wird u. a. auf das hohe risiko perinataler Hirnschadigungen mit erhohter Vulnerabilitat thalamo-kortikaler Verbindungen zuruckgefuhrt. Basierend auf den in einer Vorgangerstudie gefundenen funktionellen Konnektivitatsveranderungen zwischen hinterem ruhenetzwerk (pDMN) und dorsomedialem Thalamus bei fruhgeborenen Erwachsenen sollte in dieser studie mittels DTI ein mogliches strukturelles Korrelat identifiziert werden. Methoden: Im rahmen der bayrischen Entwicklungsstudie (bEsT) wurden bei 155 Personen im Alter von 26 Jahren (hiervon 82 Fruhgeborene) mithilfe probabilistischer traktographie (pDMN-thalamus) Konnektivitatskarten des Thalamus erstellt. Gruppenunterschiede in der strukturellen Konnektivitat wurden mithilfe von voxelweisen t-tests untersucht und auf einen Zusammenhang zu kognitiven Parametern (Gesamt-IQ) in einem multiplen regressionsmodell getestet. Ergebnisse: Fruhgeborene zeigten eine statistisch signifikant erhohte strukturelle Konnektivitat zwischen spezifischen thalamischen Nuclei (dorsomediale thalamuskerne sowie Pulvinar) und kortikalen regionen des pDMN (p < 0.05, FWR korrigiert, s. Abb. 1). Der IQ-Wert der Fruhgeborenen konnte durch diese Veranderungen signifikant vorhergesagt werden ([beta] = -0.32, p = 0.004). Diskussion: Unsere Ergebnisse sprechen fur langfristige Effekte einer Fruhgeburt auf die strukturelle Konnektivitat zwischen thalamuskernen hoherer Ordnung und dem pDMN. Die tatsache, dass diese Veranderungen mit einem reduzierten Gesamt-IQ bei den Fruhgeborenen einhergehen, unterstreicht die relevanz fur die Kognition.
Journal Article
Analysis of unsuccessful intubations in neonates using videolaryngoscopy recordings
ObjectivesNeonatal intubation is a difficult skill to learn and teach. If an attempt is unsuccessful, the intubator and instructor often cannot explain why. This study aims to review videolaryngoscopy recordings of unsuccessful intubations and explain the reasons why attempts were not successful.Study designThis is a descriptive study examining videolaryngoscopy recordings obtained from a randomised controlled trial that evaluated if neonatal intubation success rates of inexperienced trainees were superior if they used a videolaryngoscope compared with a laryngoscope. All recorded unsuccessful intubations were included and reviewed independently by two reviewers blinded to study group. Their assessment was correlated with the intubator’s perception as reported in a postintubation questionnaire. The Cormack-Lehane classification system was used for objective assessment of laryngeal view.ResultsRecordings and questionnaires from 45 unsuccessful intubations were included (15 intervention and 30 control). The most common reasons for an unsuccessful attempt were oesophageal intubation and failure to recognise the anatomy. In 36 (80%) of intubations, an intubatable view was achieved but was then either lost, not recognised or there was an apparent inability to correctly direct the endotracheal tube. Suctioning was commonly performed but rarely improved the view.ConclusionsLack of intubation success was most commonly due to failure to recognise midline anatomical structures. Trainees need to be taught to recognise the uvula and epiglottis and use these landmarks to guide intubation. Excessive secretions are rarely a factor in elective and premedicated intubations, and routine suctioning should be discouraged. Better blade design may make it easier to direct the tube through the vocal cords.
Journal Article
Challenges of a simplified opt-out consent process in a neonatal randomised controlled trial: qualitative study of parents’ and health professionals’ views and experiences
BackgroundMore effective recruitment strategies like alternative approaches to consent are needed to facilitate adequately powered trials. Witholding Enteral feeds Around Transfusion was a multicentre, randomised, pilot trial that compared withholding and continuing feeds around transfusion. The primary clinical outcome was necrotising enterocolitis. The trial used simplified opt-out consent with concise parent information and no consent form.ObjectiveTo explore the views and experiences of parents and health professionals on the acceptability and feasibility of opt-out consent in randomised comparative effectiveness trials.MethodsA qualitative, descriptive interview-based study nested within a randomised trial. Semistructured interview transcripts were analysed using inductive thematic analysis.SettingEleven neonatal units in England.ParticipantsEleven parents and ten health professionals with experience of simplified consent.ResultsFive themes emerged: ‘opt-out consent operationalised as verbal opt-in consent’, ‘opt-out consent normalises participation while preserving parental choice’, ‘opt-out consent as an ongoing process of informed choice’, ‘consent without a consent form’ and ‘choosing to opt out of a comparative effectiveness trial’, with two subthemes: ‘wanting “normal care”’ and ‘a belief that feeding is better’.ConclusionIntroducing a novel form of consent proved challenging in practice. The principle of a simplified, opt-out approach to consent was generally considered feasible and acceptable by health professionals for a neonatal comparative effectiveness trial. The priority for parents was having the right to decide about trial participation, and they did not see opt-out consent as undermining this. Describing a study as ‘opt-out’ can help to normalise participation and emphasise that parents can withdraw consent.
Journal Article