Document Detail


Predicting the need for ventilation in term and near-term neonates.
MedLine Citation:
PMID:  15265184     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether the need for respiratory support can be predicted by oxygen requirement within the first 72 h in term and near-term infants. METHODS: To mimic the population of infants that would often be delivered outside a tertiary centre we studied a retrospective cohort of infants > or = 32 weeks requiring oxygen, divided into three groups: cot oxygen only, nasal continuous positive airway pressure (NCPAP) only, or intermittent positive pressure ventilation (IPPV). We recorded each infant's peak fraction of inspired oxygen (FiO2)--i.e. FiO2 in the first 72 h in the cot oxygen only group or maximum FiO2 prior to commencing the highest level of respiratory support. The peak FiO2 was used as a diagnostic test to predict any respiratory support or IPPV--sensitivity and specificity were calculated and receiver operating characteristic (ROC) curves plotted (FiO2 0.21-1.00) to identify the best balance point for prediction. RESULTS: The cohort included 592 infants: 516 cot oxygen only, 46 NCPAP only and 30 IPPV. The proportion ventilated increased with increasing peak FiO2--above 0.45 the proportion of infants ventilated exceeded 50%. To predict any respiratory support, the cut-point balancing sensitivity and specificity was a FiO2 > or = 0.35-58/136 required respiratory support (sensitivity = 0.76, specificity = 0.85, positive predictive value (PPV) = 43%, negative predictive value (NPV) = 96%). To predict IPPV the cut-point was a FiO2 > or = 0.5-28/47 treated with IPPV (sensitivity = 0.93, specificity = 0.97, PPV = 60%, NPV = 100%). CONCLUSION: The need for respiratory support can be predicted by oxygen requirement within the first 72 h in term and near-term infants with reasonable sensitivity and excellent specificity.
Authors:
A Morosini; M W Davies
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of paediatrics and child health     Volume:  40     ISSN:  1034-4810     ISO Abbreviation:  J Paediatr Child Health     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-07-21     Completed Date:  2004-12-02     Revised Date:  2007-09-24    
Medline Journal Info:
Nlm Unique ID:  9005421     Medline TA:  J Paediatr Child Health     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  438-43     Citation Subset:  IM    
Affiliation:
Grantley Stable Neonatal Unit, Royal Women's Hospital, Brisbane, Queensland, Australia.
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MeSH Terms
Descriptor/Qualifier:
Blood Gas Analysis
Cohort Studies
Continuous Positive Airway Pressure
Humans
Infant, Newborn
Intermittent Positive-Pressure Ventilation
Needs Assessment
Oxygen / blood*,  metabolism
Respiration, Artificial / methods,  utilization*
Respiratory Distress Syndrome, Newborn / prevention & control*
Retrospective Studies
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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