A COMPARISON OF A NEW, ULTRATHIN-WALLED TWO-STAGE TWIN ENDOTRACHEAL TUBE AND A CONVENTIONAL ENDOTRACHEAL TUBE IN VERY PREMATURE INFANTS WITH RESPIRATORY DISTRESS SYNDROME: A PILOT STUDY
Parravicine E, Baccarelli A, Wung JT, Kolobow T, Lorenz JM. Am J Perinatol. 2007;24:117-122.
A prospective pilot study was conducted using experimental, 2-group posttest design to determine the feasibility of using the ultrathin-walled 2-stage twin endoctracheal tube (UTTS-T-ETT) versus a conventional endotracheal tube (ETT).
Comparison was conducted in 28 infants randomly assigned to 2 groups for intubation: 13 infants in the UTTS-T-ETT group and 15 in the conventional ETT group. The infants were aged 24 to 28 weeks, had birth weights of >=500 g, and required intubation and mechanical ventilation. Infants in both groups were similar in gestational age, birth weight, age, and ventilator settings.
The UTTS-T-ETT has an ultrathin wall of 0.7 mm, in comparison to 1.1 to 1.4 mm for a conventional ETT. The thinner wall results in a larger internal diameter. It has a reduced length and connects to a Y-adapter, allowing connection to the inspiratory and expiratory ventilator ports. This reduces resistance and dead space volume. Currently, it is not commercially available.
There were no significant differences observed in outcomes of complications, traumatic injury to the airway, number of accidental extubations, number of reintubations, number of days of ventilation, bronchopulmonary dysplasia, length of stay, and mortality. The UTTS-T-ETT group had only 7% failed extubation attempts, versus 40% in the conventional ETT group (P = .08).
The researchers noted that there are in vitro advantages of low resistance and dead space volume. They concluded that because there was no significant difference in complications in the UTTS-T-ETT group, and there were less failed extubation attempts in this group, a large randomized trial is warranted.
THE LONG-TERM OUTCOME IN SURVIVING INFANTS WITH APGAR AERO AT 10 MINUTES: A SYSTEMATIC REVIEW OF THE LITERATURE AND HOSPITAL-BASED COHORT
Harrington DJ, Redman CW, Moulden M, Greenwood CE. Am J Obstet Gynecol. 2007;196:463e1-463e5.
A systematic literature review combined with a prospective cohort study was conducted to evaluated outcomes of infants who had been successfully resuscitated after an Apgar score of 0 at 10 minutes.
Upon review of the literature, only 7 studies were published that met criteria of listing outcomes of infants with an Apgar score of 0 at 10 minutes. These studies provided data regarding a total of 85 infants.
Researchers reviewed the medical records of infants 24 weeks or older at the John Radcliffe Hospital, Oxford, United Kingdom, between January 1 and December 31, 2004. Those born with congenital abnormalities at the hospital were excluded. This provided a sample of 9 infants. Six of the infants died before discharge. One infant died at 11 months with severe quadriparesis and microcephaly. One infant, in a 5-year follow-up examination, has severe spastic quadriparesis and severe global delay. A single infant had mild motor delay at 2 years of age.
Data from the literature review and hospital record examination were compared for analysis. Similar to the review of hospital records, most infants in the studies died. Those who survived did so usually with severe disability.
The researchers concluded, "These findings present strong evidence that adequate resuscitation beyond 10 minutes is not justified." However, this author cautions that due to study limitations, 1 infant surviving with mild disability, and the ethical implications of denying the opportunity of life for those infants who may survive with severe disability, the researchers' conclusion needs to be carefully considered. Other studies need to be conducted to discern whether such a conclusion is warranted. This is particularly the case due to ethical implications inherent in such a decision not to resuscitate infants with an Apgar score of 0 beyond 10 minutes.