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Article ; Online: The carotid body and arousal in the fetus and neonate.

Darnall, Robert A

2012 Volume 185, Issue 1, Page(s) 132–143

Abstract: Arousal from sleep is a major defense mechanism in infants against hypoxia and/or hypercapnia. Arousal failure may be an important contributor to SIDS. Areas of the brainstem that have been found to be abnormal in a majority of SIDS infants are involved ... ...

Abstract	Arousal from sleep is a major defense mechanism in infants against hypoxia and/or hypercapnia. Arousal failure may be an important contributor to SIDS. Areas of the brainstem that have been found to be abnormal in a majority of SIDS infants are involved in the arousal process. Arousal is sleep state dependent, being depressed during AS in most mammals, but depressed during QS in human infants. Repeated exposure to hypoxia causes a progressive blunting of arousal that may involve medullary raphe GABAergic mechanisms. Whereas CB chemoreceptors contribute heavily to arousal in response to hypoxia, serotonergic central chemoreceptors have been implicated in the arousal response to CO(2). Pulmonary or chest wall mechanoreceptors also contribute to arousal in proportion to the ventilatory response and decreases in their input may contribute to depressed arousal during AS. Little is known about specific arousal pathways beyond the NTS. Whether CB chemoreceptor stimulation directly stimulates arousal centers or whether this is done indirectly through respiratory networks remains unknown. This review will focus on arousal in response to hypoxia and CO(2) in the fetus and newborn and will outline what we know (and do not know) about the involvement of the carotid body in this process.
MeSH term(s)	Arousal/physiology ; Carotid Body/embryology ; Carotid Body/physiology ; Fetus/physiology ; Humans ; Infant, Newborn ; Sleep/physiology ; Sudden Infant Death/etiology
Language	English
Publishing date	2012-06-08
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2077867-3
ISSN	1878-1519 ; 1569-9048
ISSN (online)	1878-1519
ISSN	1569-9048
DOI	10.1016/j.resp.2012.06.005
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Article ; Online: Altered 5-HT2A/C receptor binding in the medulla oblongata in the sudden infant death syndrome (SIDS): Part II. Age-associated alterations in serotonin receptor binding profiles within medullary nuclei supporting cardiorespiratory homeostasis.

Cummings, Kevin J / Leiter, James C / Trachtenberg, Felicia L / Okaty, Benjamin W / Darnall, Robert A / Haas, Elisabeth A / Harper, Ronald M / Nattie, Eugene E / Krous, Henry F / Mena, Othon J / Richerson, George B / Dymecki, Susan M / Kinney, Hannah C / Haynes, Robin L

Journal of neuropathology and experimental neurology

2024 Volume 83, Issue 3, Page(s) 144–160

Abstract: The failure of chemoreflexes, arousal, and/or autoresuscitation to asphyxia may underlie some sudden infant death syndrome (SIDS) cases. In Part I, we showed that some SIDS infants had altered 5-hydroxytryptamine (5-HT)2A/C receptor binding in medullary ... ...

Abstract	The failure of chemoreflexes, arousal, and/or autoresuscitation to asphyxia may underlie some sudden infant death syndrome (SIDS) cases. In Part I, we showed that some SIDS infants had altered 5-hydroxytryptamine (5-HT)2A/C receptor binding in medullary nuclei supporting chemoreflexes, arousal, and autoresuscitation. Here, using the same dataset, we tested the hypotheses that the prevalence of low 5-HT1A and/or 5-HT2A/C receptor binding (defined as levels below the 95% confidence interval of controls-a new approach), and the percentages of nuclei affected are greater in SIDS versus controls, and that the distribution of low binding varied with age of death. The prevalence and percentage of nuclei with low 5-HT1A and 5-HT2A/C binding in SIDS were twice that of controls. The percentage of nuclei with low 5-HT2A/C binding was greater in older SIDS infants. In >80% of older SIDS infants, low 5-HT2A/C binding characterized the hypoglossal nucleus, vagal dorsal nucleus, nucleus of solitary tract, and nuclei of the olivocerebellar subnetwork (important for blood pressure regulation). Together, our findings from SIDS infants and from animal models of serotonergic dysfunction suggest that some SIDS cases represent a serotonopathy. We present new hypotheses, yet to be tested, about how defects within serotonergic subnetworks may lead to SIDS.
MeSH term(s)	Infant ; Animals ; Humans ; Aged ; Sudden Infant Death ; Medulla Oblongata/metabolism ; Serotonin/metabolism ; Receptors, Serotonin/metabolism
Chemical Substances	Serotonin (333DO1RDJY) ; Receptors, Serotonin
Language	English
Publishing date	2024-02-07
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3088-0
ISSN	1554-6578 ; 0022-3069
ISSN (online)	1554-6578
ISSN	0022-3069
DOI	10.1093/jnen/nlae004
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Article ; Online: Does the RAM Cannula Provide Continuous Positive Airway Pressure as Effectively as the Hudson Prongs in Preterm Neonates?

Singh, Neetu / McNally, Matthew J / Darnall, Robert A

American journal of perinatology

2018 Volume 36, Issue 8, Page(s) 849–854

Abstract: Objective: To compare the level of continuous positive airway pressure (CPAP) delivered by the RAM cannula system (Neotech, Valencia, CA) with that delivered by a traditional CPAP nasal delivery interface (Hudson prongs; Hudson-RCI, Temecula, CA) in ... ...

Abstract	Objective: To compare the level of continuous positive airway pressure (CPAP) delivered by the RAM cannula system (Neotech, Valencia, CA) with that delivered by a traditional CPAP nasal delivery interface (Hudson prongs; Hudson-RCI, Temecula, CA) in preterm infants with respiratory distress. Methods: This was a crossover intervention study in a convenience sample of preterm infants with respiratory distress requiring treatment with CPAP. We measured the mean intraoral (pharyngeal) pressure, which approximates the applied CPAP level, using both the RAM cannula and Hudson prongs. The primary outcome was a comparison of the differences between the set CPAP levels and the measured intraoral pressures of both delivery systems. Results: We analyzed data from 12 preterm infants with mean (standard deviation) birth weight of 1,225 (405) g and gestational age of 28.4 (2.1) weeks at a median postnatal age of 10 days. The mean difference (95% confidence interval) between the set CPAP level and measured intraoral pressure was -2.45 cm H Conclusion: For given set CPAP pressure level in preterm infants, the RAM cannula system consistently delivers lower pharyngeal pressure (effective CPAP) levels than Hudson prongs.
MeSH term(s)	Cannula ; Continuous Positive Airway Pressure/instrumentation ; Cross-Over Studies ; Equipment Design ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intubation, Intratracheal/instrumentation ; Nose ; Pressure ; Respiratory Distress Syndrome, Newborn/therapy
Language	English
Publishing date	2018-11-05
Publishing country	United States
Document type	Clinical Trial ; Comparative Study ; Journal Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/s-0038-1675330
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Article ; Online: The role of CO(2) and central chemoreception in the control of breathing in the fetus and the neonate.

Darnall, Robert A

Respiratory physiology & neurobiology

2010 Volume 173, Issue 3, Page(s) 201–212

Abstract: Central chemoreception is active early in development and likely drives fetal breathing movements, which are influenced by a combination of behavioral state and powerful inhibition. In the premature human infant and newborn rat ventilation increases in ... ...

Abstract	Central chemoreception is active early in development and likely drives fetal breathing movements, which are influenced by a combination of behavioral state and powerful inhibition. In the premature human infant and newborn rat ventilation increases in response to CO(2); in the rat the sensitivity of the response increases steadily after ∼P12. The premature human infant is more vulnerable to instability than the newborn rat and exhibits periodic breathing that is augmented by hypoxia and eliminated by breathing oxygen or CO(2) or the administration of respiratory stimulants. The sites of central chemoreception active in the fetus are not known, but may involve the parafacial respiratory group which may be a precursor to the adult RTN. The fetal and neonatal rat brainstem-spinal-cord preparations promise to provide important information about central chemoreception in the developing rodent and will increase our understanding of important clinical problems, including The Sudden Infant Death Syndrome, Congenital Central Hypoventilation Syndrome, and periodic breathing and apnea of prematurity.
MeSH term(s)	Animals ; Animals, Newborn ; Brain/embryology ; Brain/growth & development ; Brain/physiology ; Carbon Dioxide/blood ; Chemoreceptor Cells/physiology ; Embryonic Development/physiology ; Fetal Development/physiology ; Fetus ; Humans ; Infant, Newborn ; Respiratory Physiological Phenomena
Chemical Substances	Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2010-04-23
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2077867-3
ISSN	1878-1519 ; 1569-9048
ISSN (online)	1878-1519
ISSN	1569-9048
DOI	10.1016/j.resp.2010.04.009
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Article ; Online: ALTEs: still a puzzle after all these years.

Darnall, Robert A

The Journal of pediatrics

2009 Volume 154, Issue 3, Page(s) 317–319

MeSH term(s)	Airway Obstruction/diagnosis ; Airway Obstruction/epidemiology ; Apnea/diagnosis ; Apnea/epidemiology ; Canada/epidemiology ; Comorbidity ; Cyanosis/diagnosis ; Cyanosis/epidemiology ; Humans ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; Monitoring, Physiologic ; Muscle Hypotonia/diagnosis ; Muscle Hypotonia/epidemiology ; Respiratory Tract Infections/epidemiology ; Risk Factors ; Sudden Infant Death/diagnosis ; Sudden Infant Death/epidemiology ; Terminology as Topic
Language	English
Publishing date	2009-03
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2008.09.041
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Article ; Online: Does Diaphragmatic Electrical Activity in Preterm Infants Predict Extubation Success?

Singh, Neetu / McNally, Matthew J / Darnall, Robert A

Respiratory care

2017 Volume 63, Issue 2, Page(s) 203–207

Abstract: Background: Despite many advances in respiratory care and mechanical ventilation, neonatologists lack an objective tool to aid in decision making for timely extubation. Electrical activity of the diaphragm (EA: Methods: We examined peak EA: Results! ...

Abstract	Background: Despite many advances in respiratory care and mechanical ventilation, neonatologists lack an objective tool to aid in decision making for timely extubation. Electrical activity of the diaphragm (EA Methods: We examined peak EA Results: Twenty one premature infants with respiratory distress syndrome included in the study had a mean ± SD) gestational age of 28 ± 2.6 weeks and mean birthweight of 1,208 ± 611 g. The first extubation attempt occurred at a median age of 1 d (interquartile range 1-2 d). One third of the infants failed the first extubation attempt. Infants with failed extubations were significantly smaller (mean ± SD birthweight 788 ± 266 g versus 1,417 ± 632 g) and of lower gestational age (mean ± SD 26 ± 1.9 weeks versus 29 ± 2.6 weeks) compared with those with successful extubation. Mean peak EA Conclusions: This small study suggests that the pre-extubation peak EA
MeSH term(s)	Airway Extubation/methods ; Diaphragm/physiopathology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Inspiratory Capacity/physiology ; Male ; Respiration, Artificial/methods ; Respiratory Distress Syndrome, Newborn/physiopathology ; Respiratory Distress Syndrome, Newborn/therapy ; Respiratory Function Tests/methods ; Treatment Outcome ; Ventilator Weaning/methods
Language	English
Publishing date	2017-11-28
Publishing country	United States
Document type	Evaluation Studies ; Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.05539
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Article ; Online: Durable chronic low back pain reductions up to 24 months after treatment for an accessible, 8-week, in-home behavioral skills-based virtual reality program: a randomized controlled trial.

Maddox, Todd / Sparks, Charisse / Oldstone, Liesl / Maddox, Roselani / Ffrench, Kelsey / Garcia, Heidy / Krishnamurthy, Parthasarathy / Okhotin, David / Garcia, Laura M / Birckhead, Brandon J / Sackman, Josh / Mackey, Ian / Louis, Robert / Salmasi, Vafi / Oyao, Alexis / Darnall, Beth D

Pain medicine (Malden, Mass.)

2023 Volume 24, Issue 10, Page(s) 1200–1203

MeSH term(s)	Humans ; Low Back Pain/therapy ; Treatment Outcome ; Exercise Therapy ; Virtual Reality
Language	English
Publishing date	2023-05-24
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2015903-1
ISSN	1526-4637 ; 1526-2375
ISSN (online)	1526-4637
ISSN	1526-2375
DOI	10.1093/pm/pnad070
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Article ; Online: Proposed guidelines for skin-to-skin care and rooming-in should be more inclusive.

Feldman-Winter, Lori / Goodstein, Michael H / Hauck, Fern R / Darnall, Robert A / Moon, Rachel Y

Journal of perinatology : official journal of the California Perinatal Association

2018 Volume 38, Issue 9, Page(s) 1277–1278

MeSH term(s)	Breast Feeding ; Child ; Female ; Hospitals ; Humans ; Infant Care ; Postnatal Care ; Pregnancy ; Skin Care
Language	English
Publishing date	2018-07-27
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	645021-0
ISSN	1476-5543 ; 0743-8346
ISSN (online)	1476-5543
ISSN	0743-8346
DOI	10.1038/s41372-018-0175-y
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Article: Does the RAM Cannula Provide Continuous Positive Airway Pressure as Effectively as the Hudson Prongs in Preterm Neonates?

Singh, Neetu / McNally, Matthew J. / Darnall, Robert A.

American Journal of Perinatology

2018 Volume 36, Issue 08, Page(s) 849–854

Abstract	Objective: To compare the level of continuous positive airway pressure (CPAP) delivered by the RAM cannula system (Neotech, Valencia, CA) with that delivered by a traditional CPAP nasal delivery interface (Hudson prongs; Hudson-RCI, Temecula, CA) in preterm infants with respiratory distress. Methods: This was a crossover intervention study in a convenience sample of preterm infants with respiratory distress requiring treatment with CPAP. We measured the mean intraoral (pharyngeal) pressure, which approximates the applied CPAP level, using both the RAM cannula and Hudson prongs. The primary outcome was a comparison of the differences between the set CPAP levels and the measured intraoral pressures of both delivery systems. Results: We analyzed data from 12 preterm infants with mean (standard deviation) birth weight of 1,225 (405) g and gestational age of 28.4 (2.1) weeks at a median postnatal age of 10 days. The mean difference (95% confidence interval) between the set CPAP level and measured intraoral pressure was −2.45 cm H 2 O (−3.36, −1.55) with the RAM cannula and +0.40 cm H 2 O (−0.30, 1.12) with Hudson prongs, p = 0.0002. Conclusion: For given set CPAP pressure level in preterm infants, the RAM cannula system consistently delivers lower pharyngeal pressure (effective CPAP) levels than Hudson prongs.
Keywords	continuous positive airway pressure ; nasal interface ; preterm
Language	English
Publishing date	2018-11-05
Publisher	Thieme Medical Publishers
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/s-0038-1675330
Database	Thieme publisher's database

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Article ; Online: Parent-infant bedsharing is not recommended.

Hauck, Fern R / Darnall, Robert A / Moon, Rachel Y

JAMA pediatrics

2014 Volume 168, Issue 4, Page(s) 387

MeSH term(s)	Beds ; Humans ; Infant Care/trends ; Sleep
Language	English
Publishing date	2014-04
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	2701223-2
ISSN	2168-6211 ; 2168-6203
ISSN (online)	2168-6211
ISSN	2168-6203
DOI	10.1001/jamapediatrics.2013.5169
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