Background: Noninvasive ventilation has been used increasingly in recent years to minimize the duration of endotracheal mechanical ventilation in neonates due to its association with lung injury. Nasal high-frequency oscillation (nHFO) is a relatively new noninvasive modality but evidence for its use is limited. Objective: The goal of this study was to compare the CO₂ clearance efficacy of nHFO and noninvasive positive pressure ventilation (NIPPV) in a neonatal lung model. Design/Methods: A newborn mannequin with dimensions and anatomy similar to a term infant was utilized. It was connected to a commercially available neonatal mechanical ventilator using a manufacturer-provided nasal adaptor. Various modes of noninvasive ventilation were compared as CO₂ clearance was measured at the oropharynx by an end-tidal CO₂ analyzer following the addition of a known amount of CO₂ into the lung. Measurements were obtained at two different lung compliances using nHFO and compared with nCMV and nasal continuous positive airway pressure (nCPAP) as a control. Pressures near the nasal adaptor and the larynx were simultaneously measured with in-line pressure transducers. Results: Whereas no CO₂ elimination was observed under nCPAP, its clearance with nHFO was 3-fold greater as compared to NIPPV. On nHFO, CO₂ clearance was inversely proportional to frequency and maximal at 6 and 8 Hz. At a lower lung compliance, CO₂ clearance was significantly higher at 6 Hz as compared to 10 Hz. During nHFO set to deliver a MAP of 10.0, we documented pressures of 7.2 ± 0.3 at the nasal adaptor and only 2.3 ± 0.3 cm H₂O at the larynx. Conclusions: Nasal HFO is effective and superior to NIPPV at lung CO₂ elimination in a newborn mannequin model. The use of nHFO as the preferred mode of noninvasive ventilation warrants further clinical studies.

Background: Epinephrine is a component of all resuscitation algorithms. Vasopressin is a pulmonary vasodilator and systemic vasopressor. We investigated the effect of epinephrine vs. vasopressin on survival and hemodynamics after neonatal porcine cardiac arrest (CA). Methods: A 4-min asphyxial CA was induced, after which cardiopulmonary resuscitation (CPR) was commenced. Animals were randomized to low-(LDE: 0.01 mg/kg) or high-dose epinephrine (HDE: 0.03 mg/kg), low-(LDV: 0.2 U/kg) or high-dose vasopressin (HDV: 0.4 U/kg), or control (saline). Clinical and echocardiography indexes were monitored. results: Sixty-nine animals were randomized. Survival was greater in HDV (n = 8 (89%); P < 0.05 ANOVA) vs. control (n = 7 (43%)) and LDE (n = 5 (36%)) but not vs. HDE (n = 7 (64%)) or LDV (n = 6 (75%)). Animals resuscitated with LDE required more shocks (2.5 (interquartile range: 2-6); P < 0.05) and higher doses of energy (15 J (interquartile range: 10-20); P < 0.05). Left ventricular output was comparable between groups, but a greater increase in superior vena caval flow was seen after HDV (P < 0.001 vs. control, LDE, and HDE). Plasma troponin was greatest in the HDE group (P < 0.05 vs. control and HDV). conclusion: Vasopressin results in improved survival, lower postresuscitation troponin, and less hemodynamic compromise after CA in newborn piglets. Vasopressin may be a candidate for testing in human neonates. t he need for active neonatal resuscitation is common with an incidence of 5-10%, although there is likely to be regional variability (1). Guidelines for drug use in neonatal resuscitation guidelines are based on extrapolations from adult literature. Pressors, almost invariably epinephrine, are recommended as core therapy during cardiopulmonary resuscitation (CPR) in order to enhance systemic perfusion (especially cerebral and coronary perfusion) by maintaining vascular tone while forward flow is generated by chest compressions. Epinephrine, although an integral part of every published protocol for neonatal resuscitation, may be associated with adverse effects (2-6); similar concerns exist in pediatric and adult cardiac arrest (CA). However, because of concerns associated with epinephrine (2,7), vasopressin was studied in the setting of asystolic CA. Vasopressin is an intense systemic vasoconstrictor, which may explain why it increases cerebral (and systemic) perfusion during experimental cardiac massage, as well as increasing cerebral oxygenation, neurological outcome, and resuscitation success following experimental .Vasopressin was first proposed as a resuscitation agent after endogenous vasopressin levels were found to be higher in successfully resuscitated patients compared with those who died (13). Evidence from a large, adult, multicenter, randomized controlled trial suggests it to be superior to epinephrine, when the nature of the CA was primary asystole (14). For the following reasons, vasopressin may be a good candidate for pressor support during CPR. First, CA in neonates is almost always due to asphy...

Objectives. To examine current opinions and practices regarding endotracheal tube placement across several Canadian Neonatal Intensive Care Units. Design. Clinical directors from Canadian Neonatal Network affiliated NICUs and Neonatal-Perinatal Programs across Canada were invited via email to participate in and disseminate the online survey to staff neonatologists, neonatal fellows, respiratory therapists, and nurse practitioners. Result. There is wide variability in the beliefs and practices related to ETT placement. The majority use “weight +6” formula and “aim to black line” on ETT at vocal cords to estimate the depth of an oral ETT and reported estimation as challenging in ELBW infants. The majority agreed that mid-trachea is an ideal ETT tip position; however their preferred position on chest X-ray varied. Many believe that ETT positioning could be improved with more precise ETT markings. Conclusion. Further research should focus on developing more effective guidelines for ETT tip placement in the ELBW infants.