A daily physical activity programme increased SOS values of the tibia and mid-upper arm circumference in VLBW pre-term infants.

The aim of this study was to evaluate the changes in bone mineral density and anthropometric indices of extremely low birth weight (ELBW) preterm infants undergoing daily physical activity. Twenty-eight low-risk ELBW preterm infants (intervention group = 14, control group = 14) with a birth weight of under 1000 g and gestational age of 26-32 weeks were recruited. Preterm infants in the control group were provided with standard nursing care, whereas those in the intervention group received a daily physical activity programme in addition to standard nursing care during the study. Before and after the study, anthropometric indices and tibial speed of sound (SOS) values were measured. In this study, the tibial SOS values were found to be increased in the intervention group (+111.14 m/s) (p = 0.001) and decreased in the control group (-58.21 m/s) (p = 0.030). The increase in percentage of body weight, height, and tibial length of infants in the intervention group was significantly higher than in the control group (respectively; p = 0.002, p = 0,015, p < 0.001). A daily physical activity programme increased body weight, height, tibial length, and SOS values of the tibia in ELBW preterm infants.

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Pediatr Crit Care Med 2014 • Volume 15 • Number 4 (Suppl.)MV with breathing efforts. In adults, patient-ventilator asynchrony is independently associated with longer MV duration. Aims: To study patient-ventilator asynchrony in critically ill children and its impact on MV duration. Methods: Prospective observational study approved by local IRB and conducted in patients 1-week to 18-years old, with acute conventional MV and spontaneous breathing efforts. After parental consent, diaphragm electrical activity (EAdi) was recorded using a specific nasogastric catheter to assess patient ventilatory drive. Ventilatory pressure (Pvent) was obtained to reflect ventilator action. EAdi and Pvent plots were analyzed by two independent investigators to quantify asynchrony parameters, including trigger and cycling-off delays, non-assisted breaths, and auto-triggered assists. Medians (interquartiles) are reported. Results: 52 patients 9 (1-35) months old were evaluated 3 (1-7) days after intubation. Trigger and cycling off delays were 143 (80-240)ms and 150 (-120-360)ms, corresponding to 20 (16-36)% of time. In addition, 15 (4-35)% breaths were non-assisted, and 7 (2-19)% assists were autotriggered. 29% patients had very little drive (EAdi <2 mcV). Asynchrony and MV duration were not correlated. Conclusions: The children and the ventilator were poorly synchronized. This asynchrony may be due to inefficient ventilator trigger, or inappropriate settings. Excessive sedation or overassistance may also play a role, as suggested by the frequency of low EAdi. Asynchrony was not associated with MV duration, but the rarity of good synchrony makes it difficult to interpret. Further studies should evaluate strategies to improve synchrony.