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Article: Neonatal Airway Management.

Pinheiro, Joaquim M B

2024 Volume 11, Issue 1

Abstract: The neonatal airway is often difficult to secure, whether the practitioner responsible for managing the airway is a neonatologist, pediatrician, anesthesiologist, another specialist or an advanced practice provider [ ... ]. ...

Abstract	The neonatal airway is often difficult to secure, whether the practitioner responsible for managing the airway is a neonatologist, pediatrician, anesthesiologist, another specialist or an advanced practice provider [...].
Language	English
Publishing date	2024-01-10
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children11010082
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Leveraging Telemedicine to Spread Expertise in Neonatal Resuscitation.

Pinheiro, Joaquim M B

Children (Basel, Switzerland)

2022 Volume 9, Issue 3

Abstract: The development and potential applications of telemedicine in neonatal resuscitation were reviewed by Donohue and colleagues in 2019, in a manuscript that compiled seminal references in the field [ ... ]. ...

Abstract	The development and potential applications of telemedicine in neonatal resuscitation were reviewed by Donohue and colleagues in 2019, in a manuscript that compiled seminal references in the field [...].
Language	English
Publishing date	2022-03-01
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children9030326
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Article: Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube-Literature Review and Experience at a Tertiary Center.

Pinheiro, Joaquim M B / Munshi, Upender K / Chowdhry, Rehman

Children (Basel, Switzerland)

2023 Volume 10, Issue 2

Abstract: Unintended endobronchial placement is a common complication of neonatal tracheal intubation and a threat to patient safety, but it has received little attention towards decreasing its incidence and mitigating associated harms. We report on the key ... ...

Abstract	Unintended endobronchial placement is a common complication of neonatal tracheal intubation and a threat to patient safety, but it has received little attention towards decreasing its incidence and mitigating associated harms. We report on the key aspects of a long-term project in which we applied principles of patient safety to design and implement safeguards and establish a safety culture, aiming to decrease the rate of deep intubation (beyond T3) in neonates to <10%. Results from 5745 consecutive intubations revealed a 47% incidence of deep tube placement at baseline, which decreased to 10-15% after initial interventions and remained in the 9-20% range for the past 15 years; concurrently, rates of deep intubation at referring institutions have remained high. Root cause analyses revealed multiple contributing factors, so countermeasures specifically aimed at improving intubation safety should be applied before, during, and immediately after tube insertion. Extensive literature review, concordant with our experience, suggests that pre-specifying the expected tube depth before intubation is the most effective and simple intervention, although further research is needed to establish accurate and accepted standards for estimating the expected depth. Presently, team training on intubation safety, plus possible technological advances, offer additional options for safer neonatal intubations.
Language	English
Publishing date	2023-02-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children10020361
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Article: Tracheal Length Measurement in Intubated Neonates to Guide the Design and Use of Endotracheal Tube Glottic Depth Markings.

Cerone, Jennifer B / Pinheiro, Joaquim M B

Children (Basel, Switzerland)

2022 Volume 9, Issue 2

Abstract: Background: Data on neonatal tracheal length are needed to inform the standardization of safety features for endotracheal tubes (ETTs) such as glottic depth markings. Laryngotracheal airway measurements are available from digital imaging in infants and ... ...

Abstract	Background: Data on neonatal tracheal length are needed to inform the standardization of safety features for endotracheal tubes (ETTs) such as glottic depth markings. Laryngotracheal airway measurements are available from digital imaging in infants and children but not in neonates. We aimed to determine the tracheal length (TL) of intubated preterm and term neonates. Methods: An observational study was performed on 57 neonates of 22-42 weeks' gestation and <1 week of age. Two clinicians independently reviewed 153 digital chest radiographs to determine the carina position and TL. TL was measured from carina to mid-C4 (cricoid level). We analyzed interrater agreement (within 0.5 vertebral levels) on the position of the carina and TL. TL was plotted as a function of gestational age and weight, using graphical and regression analyses. Results: Carina position ranged from T3 to T5.5, with an interrater agreement of 95%. On image pairs concordant for carina position, TL determinations were virtually identical between readers (mean difference 0.1 mm, 95% CI -0.5-0.6 mm). Average mid-tracheal length overlies the body of T1. In infants aged less than 32 weeks' gestation, the mid-trachea lies <20 mm from the carina or the larynx. TL linearly correlates with gestational age, but correlation with birthweight best fits a segmented regression with a node at 1 kg. Conclusions: The functional length of the laryngotracheal airway can be reliably measured in sick neonates. It correlates well with gestational age and birthweight, and this information can inform the redesign of ETT markings to promote the safer use of these devices.
Language	English
Publishing date	2022-01-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children9020169
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Article: Laryngeal Masks in Neonatal Resuscitation-A Narrative Review of Updates 2022.

Mani, Srinivasan / Pinheiro, Joaquim M B / Rawat, Munmun

Children (Basel, Switzerland)

2022 Volume 9, Issue 5

Abstract: Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced ... ...

Abstract	Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced resuscitation such as intubation, chest compression, and epinephrine. Every 30 s delay in initiation of PPV increased the risk of death or morbidity by 16%. The most effective interface for providing PPV in the early phases of resuscitation is still unclear. Laryngeal masks (LMs) are supraglottic airway devices that provide less invasive and relatively stable airway access without the need for laryngoscopy which have been studied as an alternative to face masks and endotracheal tubes in the initial stages of neonatal resuscitation. A meta-analysis found that LM is a safe and more effective alternative to face mask ventilation in neonatal resuscitation. LM is recommended as an alternative secondary airway device for the resuscitation of infants > 34 weeks by the International Liaison Committee on Resuscitation. It is adopted by various national neonatal resuscitation guidelines across the globe. Recent good-quality randomized trials have enhanced our understanding of the utility of laryngeal masks in low-resource settings. Nevertheless, LM is underutilized due to its variable availability in delivery rooms, providers’ limited experience, insufficient training, preference for endotracheal tube, and lack of awareness.
Language	English
Publishing date	2022-05-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children9050733
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Article ; Online: Randomized Trial of Surfactant Therapy via Laryngeal Mask Airway Versus Brief Tracheal Intubation in Neonates Born Preterm.

Gallup, Jacqueline A / Ndakor, Sussan Mbi / Pezzano, Chad / Pinheiro, Joaquim M B

The Journal of pediatrics

2022 Volume 254, Page(s) 17–24.e2

Abstract: Objective: To evaluate the possible noninferiority of surfactant administration via laryngeal mask airway (LMA) vs endotracheal tube (ETT) in avoiding the requirement for mechanical ventilation in preterm neonates with respiratory distress syndrome (RDS) ...

Abstract	Objective: To evaluate the possible noninferiority of surfactant administration via laryngeal mask airway (LMA) vs endotracheal tube (ETT) in avoiding the requirement for mechanical ventilation in preterm neonates with respiratory distress syndrome (RDS). Study design: This was a randomized controlled trial including infants born at 27 to 36 weeks of gestation, >800 g, diagnosed with RDS and receiving fraction of inspired oxygen 0.30-0.60 via noninvasive respiratory support. Infants were randomized to surfactant via LMA (with atropine premedication) or ETT (InSuRE approach with atropine and remifentanil premedication). Primary outcome was failure of surfactant treatment to prevent the need for mechanical ventilation. Results: Patients were randomized, 51 to LMA and 42 to the ETT group. Both groups had similar baseline characteristics, with birth weights ranging from 810 to 3560 g. Failure rate was 29% in the ETT group and 20% in the LMA group (P = .311). This difference was due to early failures (within 1 hour), with 12.5% in the ETT group and 2% in the LMA group (P = .044). Surfactant therapy via LMA was non-inferior to administration via ETT; failure risk difference -9.0% (CI -∞ to 5.7%). Efficacy in decreasing fraction of inspired oxygen, number of surfactant doses administered, time to wean off all respiratory support, rates of adverse events, and outcomes including pneumothorax and BPD diagnosis did not differ between groups. Conclusions: Surfactant therapy via LMA was noninferior to administration via ETT and it decreased early failures, possibly by avoiding adverse effects of premedication, laryngoscopy, and intubation. These characteristics make LMA a desirable conduit for surfactant administration. Trial registration: ClinicalTrials.gov, NCT02164734.
MeSH term(s)	Infant, Newborn ; Humans ; Laryngeal Masks ; Surface-Active Agents/therapeutic use ; Infant, Premature ; Intubation, Intratracheal ; Pulmonary Surfactants/therapeutic use ; Lipoproteins ; Respiratory Distress Syndrome, Newborn/drug therapy ; Oxygen/therapeutic use ; Atropine Derivatives/therapeutic use
Chemical Substances	Surface-Active Agents ; Pulmonary Surfactants ; Lipoproteins ; Oxygen (S88TT14065) ; Atropine Derivatives
Language	English
Publishing date	2022-10-12
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2022.10.009
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Article ; Online: Preventing hypothermia in preterm newborns - simple principles for a complicated task.

Pinheiro, Joaquim M B

Jornal de pediatria

2017 Volume 94, Issue 4, Page(s) 337–339

MeSH term(s)	Birth Weight ; Hospitalization ; Humans ; Hypothermia ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight
Language	English
Publishing date	2017-10-31
Publishing country	Brazil
Document type	Editorial ; Introductory Journal Article ; Comment
ZDB-ID	731324-x
ISSN	1678-4782 ; 0021-7557
ISSN (online)	1678-4782
ISSN	0021-7557
DOI	10.1016/j.jped.2017.10.003
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Article: Experiences of a Regional Quality Improvement Collaborative to Reduce Unplanned Extubations in the Neonatal Intensive Care Unit.

Nelson, Melissa U / Pinheiro, Joaquim M B / Afzal, Bushra / Meyers, Jeffrey M

Children (Basel, Switzerland)

2022 Volume 9, Issue 8

Abstract: Background: Unplanned extubations (UEs) occur frequently in the neonatal intensive care unit (NICU). These events can be associated with serious short-term and long-term morbidities and increased healthcare costs. Most quality improvement (QI) ... ...

Abstract	Background: Unplanned extubations (UEs) occur frequently in the neonatal intensive care unit (NICU). These events can be associated with serious short-term and long-term morbidities and increased healthcare costs. Most quality improvement (QI) initiatives focused on UE prevention have concentrated efforts within individual NICUs. Methods: We formed a regional QI collaborative involving the four regional perinatal center (RPC) NICUs in upstate New York to reduce UEs. The collaborative promoted shared learning and targeted interventions specific to UE classification at each center. Results: There were 1167 UEs overall during the four-year project. Following implementation of one or more PDSA cycles, the combined UE rate decreased by 32% from 3.7 to 2.5 per 100 ventilator days across the collaborative. A special cause variation was observed for the subtype of UEs involving removed endotracheal tubes (rETTs), but not for dislodged endotracheal tubes (dETTs). The center-specific UE rates varied; only two centers observed significant improvement. Conclusions: A collaborative approach promoted knowledge sharing and fostered an overall improvement, although the individual centers' successes varied. Frequent communication and shared learning experiences benefited all the participants, but local care practices and varying degrees of QI experience affected each center's ability to successfully implement potentially better practices to prevent UEs.
Language	English
Publishing date	2022-08-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children9081180
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Article: The Impact of Maternal Obesity on NICU and Newborn Nursery Costs.

Azher, Sharmeen / Pinheiro, Joaquim M B / Philbin, Brendan / Gifford, Jamie / Khalak, Rubia

Frontiers in pediatrics

2022 Volume 10, Page(s) 863165

Abstract: Background: Research on the effects of maternal obesity on neonates has focused on clinical outcomes. Despite growing interest in obesity as a driver of healthcare expenditure, the financial impact of maternal obesity in the neonatal setting is little ... ...

Abstract	Background: Research on the effects of maternal obesity on neonates has focused on clinical outcomes. Despite growing interest in obesity as a driver of healthcare expenditure, the financial impact of maternal obesity in the neonatal setting is little understood. Objective: To determine if maternal obesity is associated with higher incurred costs in NICU and full-term nursery. Methods: Data for all live births (1/1/14-12/31/19) at our academic medical center was obtained from the New York State Perinatal Data System for infants >23 weeks gestational age. Financial data was obtained from the hospital's cos Results: Of the 11,610 pregnancies in this retrospective study, obese mothers more frequently had other risk factors (smoke, pre-pregnancy and gestational diabetes, and pre-pregnancy and gestational hypertension). Infants born to obese mothers were more often preterm, had Cesarean delivery, lower APGAR scores, required assisted ventilation in the delivery room, and required NICU admission. Adjusting for maternal risk factors, infants born to obese mothers were less frequently preterm (OR 0.82 [0.74-0.91], Conclusions: Maternal obesity correlates with other risk factors. Prolonged maternal stay may explain increased LOS and costs in the full-term nursery for infants born to obese mothers, as infants wait to be discharged with mothers.
Language	English
Publishing date	2022-05-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2022.863165
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Article: A Multifunctional, Low Cost and Sustainable Neonatal Database System.

Pinheiro, Joaquim M B / Fisher, Marilyn / Munshi, Upender K / Khalak, Rubia / Tauber, Kate A / Cummings, James J / Cerone, Jennifer B / Monaco-Brown, Meredith / Geis, Gina / Chowdhry, Rehman / Fay, Mary / Paul, Anshu A / Levine, Carolyn / Pan, Phillip / Horgan, Michael J

Children (Basel, Switzerland)

2024 Volume 11, Issue 2

Abstract: Continuous improvement in the clinical performance of neonatal intensive care units (NICU) depends on the use of locally relevant, reliable data. However, neonatal databases with these characteristics are typically unavailable in NICUs using paper-based ... ...

Abstract	Continuous improvement in the clinical performance of neonatal intensive care units (NICU) depends on the use of locally relevant, reliable data. However, neonatal databases with these characteristics are typically unavailable in NICUs using paper-based records, while in those using electronic records, the inaccuracy of data and the inability to customize commercial data systems limit their usability for quality improvement or research purposes. We describe the characteristics and uses of a simple, neonatologist-centered data system that has been successfully maintained for 30 years, with minimal resources and serving multiple purposes, including quality improvement, administrative, research support and educational functions. Structurally, our system comprises customized paper and electronic components, while key functional aspects include the attending-based recording of diagnoses, integration into clinical workflows, multilevel data accuracy and validation checks, and periodic reporting on both data quality and NICU performance results. We provide examples of data validation methods and trends observed over three decades, and discuss essential elements for the successful implementation of this system. This database is reliable and easily maintained; it can be developed from simple paper-based forms or used to supplement the functionality and end-user customizability of existing electronic medical records. This system should be readily adaptable to NICUs in either high- or limited-resource environments.
Language	English
Publishing date	2024-02-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children11020217
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