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Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.ORCID iD: 0000-0003-0407-2143
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is based on four articles originating from three studies conducted in the neonatal intensive care unit and the children’s operating deparment at Uppsala University Hospital, Sweden.

The overall aim was to obtain new knowledge about thermal balance and care environment in extremely preterm infants during skin-to-skin care (SSC), evaluate different methods of intraoperative monitoring of carbon dioxide (CO2), and to investigate how different levels of inhaled oxygen affect infants’ oxygenation during anesthesia and surgery. Study I investigated infant thermal balance and the physical environment for extremely preterm infants during SSC. Study II formed part of a prospective study to assess the performance of non-invasive transcutaneous and end-tidal technique to continuously monitor CO2 levels in the infants blood during anesthesia. Study III was a prospective randomized trial to investigate oxygenation during induction of anesthesia with room air versus high fraction (80%) of oxygen in healthy newborn infants.

The infants maintained normal body temperature during SSC. In comparison to care in an incubator, during SSC ambient humidity was lower and insensible water loss through the skin was higher. Compared to blood gas Pco, transcutaneous carbon dioxide monitoring yielded a bias of 0.3 ± 0.7 kPa, and end-tidal technique a bias of -1.9 ± 0.9 kPa. After intubation, saturation measured by pulse oximetry was lower (p < .05) in the group breathing room air than in the group with high oxygen (93% ± 6.7 and 99% ± 1.5). None of the infants spent time below the pre-specified safety oxygen saturation targets to mandate supplemental oxygen.

This thesis provides new knowledge about early initiation of SSC after birth for extremely preterm infants, the results will be useful to guide safe routines for implementation of early SSC. These results suggest that during anesthesia would transcutaneous monitoring of carbon dioxide be beneficial, end-tidal monitoring correlated poorly to blood gas and induction of general anesthesia in newborn infants can be safely performed without the use of high levels of supplemental oxygen. Taken together, this new knowledge has the potential to improve intraoperative respiratory management.

Place, publisher, year, edition, pages
uppsala: Acta Universitatis Upsaliensis, 2018. , p. 46
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1475
Keywords [en]
Neonatal, anesthesia, kangaroo-mother-care, skin-to-skin care, carbon dioxide
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:uu:diva-352668ISBN: 978-91-513-0375-8 (print)OAI: oai:DiVA.org:uu-352668DiVA, id: diva2:1225427
Public defence
2018-09-14, Rosensalen, Akademiska sjukhuset Ingång 95/96, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-08-24 Created: 2018-06-27 Last updated: 2018-09-07Bibliographically approved
List of papers
1. Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment
Open this publication in new window or tab >>Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment
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2012 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 161, no 3, p. 422-426Article in journal (Refereed) Published
Abstract [en]

Objective

To evaluate infant thermal balance and the physical environment in extremely preterm infants during skin-to-skin care (SSC).

Study design

Measurements were performed in 26 extremely preterm infants (gestational age 22-26 weeks; postnatal age, 2-9 days) during pretest (in incubator), test (during SSC), and posttest (in incubator) periods. Infants' skin temperature and body temperature, ambient temperature, and relative humidity were measured. Evaporimetry was used to determine transepidermal water loss, and insensible water loss through the skin was calculated.

Results

The infants maintained a normal body temperature during SSC. Transfer to and from SSC was associated with a drop in skin temperature, which increased during SSC. Ambient humidity and temperature were lower during SSC than during incubator care. Insensible water loss through the skin was higher during SSC.

Conclusion

SSC can be safely used in extremely preterminfants. SSC can be initiated during the first week of life and is feasible in infants requiring neonatal intensive care, including ventilator treatment. During SSC, the conduction of heat from parent to infant is sufficiently high to compensate for the increase in evaporative and convective heat loss. The increased water loss through the skin during SSC is small and should not affect the infant's fluid balance.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-182517 (URN)10.1016/j.jpeds.2012.02.034 (DOI)000308141700014 ()22497906 (PubMedID)
Available from: 2012-10-15 Created: 2012-10-11 Last updated: 2018-06-27Bibliographically approved
2. Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible
Open this publication in new window or tab >>Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible
2016 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, EISSN 1526-7598, Vol. 123, no 4, p. 1004-1007, article id 10.1213/ANE.0000000000001462Article in journal (Refereed) Published
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-353906 (URN)10.1213/ANE.0000000000001462 (DOI)
Available from: 2018-06-17 Created: 2018-06-17 Last updated: 2018-09-26Bibliographically approved
3. Poor performance of main-stream capnography in newborn infants during general anesthesia
Open this publication in new window or tab >>Poor performance of main-stream capnography in newborn infants during general anesthesia
2017 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, no 12, p. 1235-1240Article in journal (Refereed) Published
Abstract [en]

Background

Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated.

Aims

The aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery.

Methods

Endtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g.

Results

Endtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 7 mm Hg and a precision of +/- 14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg.

Conclusion

Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.

Keywords
capnography, infant, mechanical ventilation, neonatal, perioperative, surgery
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-341986 (URN)10.1111/pan.13266 (DOI)000414571000009 ()29072363 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-06-27
4. Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safety
Open this publication in new window or tab >>Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safety
(English)Manuscript (preprint) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-352666 (URN)
Available from: 2018-06-06 Created: 2018-06-06 Last updated: 2018-06-27

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