Diana Vargas

OBJECTIVE: To evaluate the association between orotracheal versus nasotracheal intubation route and unplanned extubation (UE) risk among infants. This retrospective cohort study included all tracheal intubation (TI) events among infants admitted to a level IV NICU from 2022 to 2024. Kaplan-Meier survival analysis was used to assess UE risk by TI route. There were 1160 TI events and 23 UEs during the study period. The UE rate was three times lower in the nasotracheal intubation group compared to orotracheal (0.01 vs. 0.03 per 100 ventilator days). UE risk was significantly higher in orotracheally intubated infants (p = 0.03) with no differences when stratified by sex, gestational age, or birth weight. Nasotracheal intubation was associated with lower UE risk in infants in a unit that predominantly performs nasotracheal intubation. Prospective randomized studies are needed to further investigate if TI route may contribute to fewer UEs in this population.

Objective To evaluate the association between orotracheal versus nasotracheal intubation route and unplanned extubation (UE) risk among neonates. Study Design: This retrospective cohort study included all tracheal intubation (TI) events among neonates admitted to a level IV NICU from 2022 to 2024. Kaplan-Meier survival analysis was used to assess UE risk by TI route. Result There were 1,160 TI events and 23 UEs during the study period. The UE rate was three times lower in nasotracheal intubation group compared to orotracheal (0.01 vs 0.03 per 100 ventilator days). UE risk was significantly higher in orotracheally intubated infants (p = 0.03) with no differences when stratified by sex, gestational age, or birth weight. Conclusion Nasotracheal intubation was associated with lower UE risk in neonates in a unit that predominantly performs nasotracheal intubation. Prospective randomized studies are needed to further investigate if TI route may contribute to fewer UEs in this population.

Objective To assess diagnostic point of care ultrasound (POCUS) use, presence of programmatic infrastructural elements, and barriers to implementation across neonatal perinatal medicine (NPM) programs in the United States. Study design Cross-sectional study. An online survey was distributed to leaders in education or POCUS at ACGME-accredited NPM fellowship programs. National trends were outlined using descriptive statistics and compared by program size. Result 79 of 99 (80%) NPM programs responded. Diagnostic POCUS was available at 71% (n = 56) of sites that responded. Key infrastructural elements were present at <45% of sites, with fellow training being the exception (71%). Many barriers to diagnostic POCUS program implementation were identified and they differed by program size. Conclusion Diagnostic POCUS is being increasingly adopted despite underdeveloped programmatic infrastructure. Identified barriers suggest a need for collaborative efforts to support the necessary infrastructural elements, and differences by program size suggest a need for tailored approaches for successful integration.

This is a single-center retrospective study to assess the safety and tolerability of continuous inhaled iloprost use as rescue therapy for refractory pulmonary hypertension (PH) in critically ill neonates and infants. A retrospective chart review was performed on 58 infants and data were collected at baseline, 1, 6, 12, 24, 48 and 72 h of iloprost initiation. Primary outcomes were change in heart rate (HR), fraction of inspired oxygen (FiO₂), mean airway pressures (MAP), blood pressure (BP) and oxygenation index (OI). Secondary outcomes were need for extracorporeal membrane oxygenation (ECMO) and death. 51 patients treated for >6 h were analyzed in 2 age groups, neonate (≤28 days: n = 32) and infant (29–365 days: n = 19). FiO₂ (p < 0.001) and OI (p = 0.01) decreased, while there were no significant changes in MAP, BP and HR. Of the fifteen patients placed on ECMO, seven were bridged off ECMO on iloprost and eight died. Twenty-four out of fifty-one patients (47%) recovered without requiring ECMO, while twelve (23%) died. Iloprost as add-on therapy for refractory PH in critically ill infants in the NICU has an acceptable tolerability and safety profile. Large prospective multicenter studies using iloprost in the neonatal ICU are necessary to validate these results.

This is a single center retrospective study to assess safety and tolerability of continuous inhaled iloprost use as rescue therapy for refractory pulmonary hypertension (PH) in critically ill neonates and infants. Retrospective chart review was performed on 58 infants and data was collected at baseline, 1, 6, 12, 24, 48, and 72 hours of iloprost initiation. Primary outcomes were change in heart rate (HR), fraction of inspired oxygen (FiO2), mean airway pressures (MAP), blood pressure (BP) and oxygenation index (OI). Secondary outcomes were need for extracorporeal membrane oxygenation (ECMO) and death. 51 patients treated for > 6 hours were analyzed in 2 age groups, neonate (≤28 days: n=32) and infant (29-365 days: n=19). FiO2 (p

BACKGROUND: Rapid genome sequencing (rGS) has been shown to improve care of critically ill infants. Congenital heart disease (CHD) is a leading cause of infant mortality and is often caused by genetic disorders, yet the utility of rGS has not been prospectively studied in this population. METHODS: We conducted a prospective evaluation of rGS to improve the care of infants with complex CHD in our cardiac neonatal intensive care unit. RESULTS: In a cohort of 48 infants with complex CHD, rGS diagnosed 14 genetic disorders in 13 (27%) individuals and led to changes in clinical management in 8 (62%) cases with diagnostic results. These included 2 cases in whom genetic diagnoses helped avert intensive, futile interventions before cardiac neonatal intensive care unit discharge, and 3 cases in whom eye disease was diagnosed and treated in early childhood. CONCLUSIONS: Our study provides the first prospective evaluation of rGS for infants with complex CHD to our knowledge. We found that rGS diagnosed genetic disorders in 27% of cases and led to changes in management in 62% of cases with diagnostic results. Our model of care depended on coordination between neonatologists, cardiologists, surgeons, geneticists, and genetic counselors. These findings highlight the important role of rGS in CHD and demonstrate the need for expanded study of how to implement this resource to a broader population of infants with CHD.