Anatomic accuracy, physiologic characteristics, and fidelity of very low birth weight infant airway simulators

Background Medical simulation training requires realistic simulators with high fidelity. This prospective multi-center study investigated anatomic precision, physiologic characteristics, and fidelity of four commercially available very low birth weight infant simulators. Methods We measured airway angles and distances in the simulators Premature AirwayPaul (SIMCharacters), Premature Anne (Laerdal Medical), Premie HAL S2209 (Gaumard), and Preterm Baby (Lifecast Body Simulation) using computer tomography and compared these to human cadavers of premature stillbirths. The simulators’ physiologic characteristics were tested, and highly experienced experts rated their physical and functional fidelity. Results The airway angles corresponded to those of the reference cadavers in three simulators. The nasal inlet to glottis distance and the mouth aperture to glottis distance were only accurate in one simulator. All simulators had airway resistances up to 20 times higher and compliances up to 19 times lower than published reference values. Fifty-six highly experienced experts gave three simulators (Premature AirwayPaul: 5.1 ± 1.0, Premature Anne 4.9 ± 1.1, Preterm Baby 5.0 ± 1.0) good overall ratings and one simulator (Premie HAL S2209: 2.8 ± 1.0) an unfavorable rating. Conclusion The simulator physiology deviated significantly from preterm infants’ reference values concerning resistance and compliance, potentially promoting a wrong ventilation technique. Impact Very low birth weight infant simulators showed physiological properties far deviating from corresponding patient reference values. Only ventilation with very high peak pressure achieved tidal volumes in the simulators, as aimed at in very low birth weight infants, potentially promoting a wrong ventilation technique. Compared to very low birth weight infant cadavers, most tested simulators accurately reproduced the anatomic angular relationships, but their airway dimensions were relatively too large for the represented body. The more professional experience the experts had, the lower they rated the very low birth weight infant simulators.

The Correlation Between Human Immunodeficiency Virus (HIV) Infections in Pregnancy and Low Birth Weight Infants

Background: The prevalence of Human Immunodeficiency Virus (HIV) infection in pregnancy were increase in developing countries. The existence of infection interferes with the absorption of nutrients due to accumulation of inflammatory cells in the placenta can cause the infant born with low birth weight. Objective: The purpose of this study was to determine the correlation of HIV infections in pregnancy and low birth weight infant. Methods: This research used an observational analytic design with a retrospective approach. The samples were positive and negative HIV mother with their infants that hospitalized at dr. Soebandi Hospital, Jember, from August 2014 - July 2017. The data were analysed by Fisher's Exact. Results: This study was found 52 positive HIV mother with their infants and 52 negative HIV mother with their infants. Nine from 52 infants (17.3%) who born from positive HIV mother were low birth weight. Only 3 from 52 infants (5.8%) who born from negative HIV mother were low birth weight. Data analysis using Fisher’s Exact was obtained p value = 0.06. Conclusion: There was no significant correlation of HIV infections in pregnancy and low birth weight infant.

Hepatic Lesions of Total Parenteral Nutrition (Tpn) Secondary to Umbilical Venous Catheter (Uvc) Malposition in A Very Low-Birth Weight Infant in China

Umbilical vein catheterization (UVC) is a common operation for vascular access in preterm infants. However, there are complications associated with their use. We here a case of extravasation of the fluids due to misplacement of the catheter causing hepatic collection of TPN in a very low-birth weight preterm (VLBW) infant.