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Solís-García G, Bravo MC, Pellicer A. Cardiorespiratory interactions during the transitional period in extremely preterm infants: a narrative review. Pediatr Res 2024:10.1038/s41390-024-03451-6. [PMID: 39179873 DOI: 10.1038/s41390-024-03451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 08/26/2024]
Abstract
We aimed to review the physiology and evidence behind cardiorespiratory interactions during the transitional circulation of extremely preterm infants with fragile physiology and to propose a framework for future research. Cord clamping strategies have a great impact on initial haemodynamic changes, and appropriate transition can be facilitated by establishing spontaneous ventilation before cord clamping. Mechanical ventilation modifies preterm transitional haemodynamics, with positive pressure ventilation affecting the right and left heart loading conditions. Pulmonary vascular resistances can be minimized by ventilating with optimal lung volumes at functional residual capacity, and other pulmonary vasodilator treatments such as inhaled nitric oxide can be used to improve ventilation/perfusion mismatch. Different cardiovascular drugs can be used to provide support during transition in this population, and it is important to understand both their cardiovascular and respiratory effects, in order to provide adequate support to vulnerable preterm infants and improve outcomes. Current available non-invasive bedside tools, such as near-infrared spectroscopy, targeted neonatal echocardiography, or lung ultrasound offer the opportunity to precisely monitor cardiorespiratory interactions in preterm infants. More research is needed in this field using precision medicine to strengthen the benefits and avoid the harms associated to early neonatal interventions. IMPACT: In extremely preterm infants, haemodynamic and respiratory transitions are deeply interconnected, and their changes have a key impact in the establishment of lung aireation and postnatal circulation. We describe how mechanical ventilation modifies heart loading conditions and pulmonary vascular resistances in preterm patients, and how hemodynamic interventions such as cord clamping strategies or cardiovascular drugs affect the infant respiratory status. Current available non-invasive bedside tools can help monitor cardiorespiratory interactions in preterm infants. We highlight the areas of research in which precision medicine can help strengthen the benefits and avoid the harms associated to early neonatal interventions.
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Affiliation(s)
- Gonzalo Solís-García
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain.
| | - María Carmen Bravo
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
- Consultant Neonatologist, Rotunda Hospital, Dublin, Ireland
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
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Roehr CC, Farley HJ, Mahmoud RA, Ojha S. Non-Invasive Ventilatory Support in Preterm Neonates in the Delivery Room and the Neonatal Intensive Care Unit: A Short Narrative Review of What We Know in 2024. Neonatology 2024:1-8. [PMID: 39173610 DOI: 10.1159/000540601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Guidelines recommend non-invasive ventilatory (NIV) support as first-line respiratory support mode in preterm infants as NIV is superior to intubation and mechanical ventilation in preventing death or bronchopulmonary dysplasia. However, with an ever-expanding variety of NIV modes available, there is much debate about which NIV modality should ideally be used, how, and when. The aims of this work were to summarise the evidence on different NIV modalities for both primary and secondary respiratory support: nCPAP, nasal high-flow therapy (nHFT), and nasal intermittent positive airway pressure ventilation (nIPPV), bi-level positive airway pressure (BiPAP), nasal high-frequency oscillatory ventilation (nHFOV), and nasally applied, non-invasive neurally adjusted ventilatory assist (NIV-NAVA) modes, with particular focus on their use in preterm infants. SUMMARY This is a narrative review with reference to published guidelines by European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. nCPAP is currently the most commonly used primary and secondary NIV modality for premature infants. However, there is increasing evidence on the superiority of nIPPV over nCPAP. No beneficial effect was found for BiPAP over nCPAP. For the use of nHFT, nHFOV, and NIV-NAVA, more studies are needed to establish their place in neonatal respiratory care. KEY MESSAGES The superiority of nIPPV over nCPAP needs to be confirmed by contemporaneous trials comparing nCPAP to nIPPV at comparable mean airway pressures. Future trials should study NIV modalities in preterm infants with comparable respiratory pathology and indications, at comparable pressure settings and with different modes of synchronisation. Importantly, future trials should not exclude infants of the smallest gestational ages.
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Affiliation(s)
- Charles C Roehr
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK,
- Faculty of Health Sciences, University of Bristol, Bristol, UK,
- Newborn Care, Southmead Hospital, North Bristol Trust, Bristol, UK,
| | - Hannah J Farley
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Ramadan A Mahmoud
- Department of Pediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Shalini Ojha
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
- Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Kumar J, Meena J, Debata P, Sundaram V, Dutta S, Kumar P. RAM Cannula versus Short Binasal Prongs for Non-invasive Ventilation in Preterm Infants: An Updated Systematic Review and Meta-analysis. Indian J Pediatr 2024:10.1007/s12098-024-05211-0. [PMID: 39085731 DOI: 10.1007/s12098-024-05211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES To compare the efficacy and safety of RAM cannula with short binasal prongs (SBPs) as nasal interfaces in preterm infants requiring nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV). METHODS The authors searched electronic databases (Medline, Embase, and Web of Science) and trial registries from inception until March 15, 2024, for randomized controlled trials (RCTs) comparing the RAM cannula with SBP for delivering nCPAP/NIPPV. They performed a random-effects meta-analysis using RevMan 5.4 software. The primary outcome was failure of nCPAP/NIPPV. Secondary outcomes included nasal injury, mechanical ventilation, air leaks, and mortality. RESULTS Five RCTs (825 participants) were included. There was no significant difference in nCPAP/NIPPV failure (RR: 1.04; 95% CI: 0.58 to 1.87) or the need for invasive mechanical ventilation (RR: 1.23; 95% CI: 0.75 to 2.01) between the RAM cannula and SBP groups (low to very low certainty). Compared with infants in the SBP group, those in the RAM cannula group had a significantly lower incidence of moderate to severe nasal injury [(5 RCTs, 825 participants; RR: 0.34; 95% CI: 0.18 to 0.66); low certainty] and any nasal injury [(RR: 0.44; 95% CI: 0.26 to 0.76; very low certainty)]. There was no significant difference in the other clinical outcomes. CONCLUSIONS In comparison to SBP, the RAM cannula may have little to no effect on nCPAP/NIPPV failure, but the evidence is very uncertain. Low-certainty evidence suggests that the use of RAM cannula possibly results in reduction in moderate to severe nasal trauma in preterm infants receiving nCPAP/NIPPV.
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Affiliation(s)
- Jogender Kumar
- Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Jitendra Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Debata
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Venkataseshan Sundaram
- Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sourabh Dutta
- Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Praveen Kumar
- Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Healy H, Whitesel E, Mao W, Day CL, Murphy TG, Song CH, Williams PK, Brachio SS, Cham P, Vartanian RJ, Chin S, Arora P, Bizzarro M, Sink DW, Zupancic JAF, Gupta M. Measuring practice preference variation for quality improvement in neonatal respiratory care. J Perinatol 2024; 44:1001-1008. [PMID: 38589537 DOI: 10.1038/s41372-024-01956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES The authors sought to measure and compare practice preference variation in neonatal respiratory care within and between neonatal intensive care units (NICUs) using the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT). STUDY DESIGN Eleven NICUs completed the NSIGHT between 2019 and 2021. Net preference was measured by mean response; agreement was ranked by standard distribution of response values. Heat maps showed comparisons between NICUs and disciplines. RESULTS NICUs and individuals agreed most often on use of pressure support with mandatory ventilation and on use of non-invasive positive pressure ventilation for apnea. High preference variation surrounded decisions for invasive ventilation versus continuous positive airway pressure for extremely low birth weight infants. Preference difference was most frequent between neonatologists and nurses. CONCLUSIONS Patterns of practice preference variation in neonatal respiratory care are specific to clinical scenario. Measuring preference variation may inform psychology of change and strengthen quality improvement efforts.
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Affiliation(s)
- Helen Healy
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | - Emily Whitesel
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Wenyang Mao
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Colby L Day
- University of Florida Jacksonville/Wolfson Children's Hospital, Jacksonville, FL, USA
| | | | - Clara H Song
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Sandhya S Brachio
- Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, Manhattan, NY, USA
| | | | | | - Steven Chin
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Puneet Arora
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Munish Gupta
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Wang N, Lu KY, Jiang SY, Wu HW, Cheng R, Pan ZJ, Wang HY. The current clinical landscape of neonatal respiratory failure in Jiangsu Province of China: patient demographics, NICU treatment interventions, and patient outcomes. BMC Pediatr 2024; 24:272. [PMID: 38664650 PMCID: PMC11044282 DOI: 10.1186/s12887-024-04741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION Neonatal respiratory failure (NRF) is a serious condition that often has high mortality and morbidity, effective interventions can be delivered in the future by identifying the risk factors associated with morbidity and mortality. However, recent advances in respiratory support have improved neonatal intensive care units (NICUs) care in China. We aimed to provide an updated review of the clinical profile and outcomes of NRF in the Jiangsu province. METHODS Infants treated for NRF in the NICUs of 28 hospitals between March 2019 and March 2022 were retrospectively reviewed. Data collected included baseline perinatal and neonatal parameters, NICU admission- and treatment-related data, and patient outcomes in terms of mortality, major morbidity, and survival without major morbidities. RESULTS A total of 5548 infants with NRF were included in the study. The most common primary respiratory disorder was respiratory distress syndrome (78.5%). NRF was managed with non-invasive and invasive respiratory support in 59.8% and 14.5% of patients, respectively. The application rate of surfactant therapy was 38.5%, while that of neonatal extracorporeal membrane oxygenation therapy was 0.2%. Mortality and major morbidity rates of 8.5% and 23.2% were observed, respectively. Congenital anomalies, hypoxic-ischemic encephalopathy, invasive respiratory support only and inhaled nitric oxide therapy were found to be significantly associated with the risk of death. Among surviving infants born at < 32 weeks of gestation or with a birth weight < 1500 g, caffeine therapy and repeat mechanical ventilation were demonstrated to significantly associate with increased major morbidity risk. CONCLUSION Our study demonstrates the current clinical landscape of infants with NRF treated in the NICU, and, by proxy, highlights the ongoing advancements in the field of perinatal and neonatal intensive care in China.
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Affiliation(s)
- Na Wang
- Department of Neonatology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Ke-Yu Lu
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Gulou District, No.72, Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Shan-Yu Jiang
- Department of Neonatology, Wuxi Maternity and Child Health Care Hospital, Wuxi, Jiangsu, China
| | - Hong-Wei Wu
- Department of Neonatology, Xuzhou Children's Hospital Affiliated to Xuzhou medical University, Xuzhou, Jiangsu, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Gulou District, No.72, Guangzhou Road, Nanjing, 210008, Jiangsu, China.
| | - Zhao-Jun Pan
- Department of Neonatology, Huai'an maternal and child health care center, Huai'an City, No. 104, Renmin South Road, Qingpu District, Jiangsu, 223001, China.
| | - Huai-Yan Wang
- Department of Neonatology, Changzhou Maternity and Child Health Care Hospital, Nanjing Medical University, No.16 Dingxiang Road, Changzhou, 213003, Jiangsu, China.
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Huang TR, Chen HL, Yang ST, Su PC, Chung HW. The Outcomes of Preterm Infants with Neonatal Respiratory Distress Syndrome Treated by Minimally Invasive Surfactant Therapy and Non-Invasive Ventilation. Biomedicines 2024; 12:838. [PMID: 38672192 PMCID: PMC11048199 DOI: 10.3390/biomedicines12040838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
In recent years, the utilization of minimally invasive surfactant therapy (MIST) and Non-invasive ventilation (NIV) as the primary respiratory assistance has become increasingly prevalent among preterm infants with neonatal respiratory distress syndrome (RDS). This study aims to compare the outcomes between MIST administered with nasal continuous positive airway pressure (NCPAP) versus nasal intermittent positive pressure ventilation (NIPPV), with the objective of exploring the respiratory therapeutic benefits of these two approaches. This retrospective study collected data from the neonatal intensive care unit of Kaohsiung Medical University Hospital spanning from January 2016 to June 2021. Infants were divided into two groups based on the type of NIV utilized. The NCPAP group comprised 32 infants, while the NIPPV group comprised 22 infants. Statistical analysis revealed significant differences: the NIPPV group had a smaller gestational age, lower birth weight, higher proportion of female infants, and earlier initiation of MIST. Additionally, the NIPPV group exhibited higher incidence rates of retinopathy of prematurity, longer respiratory support duration, prolonged hospitalization, and mortality. However, upon adjustment, these differences were not statistically significant. Analysis of venous blood gas and respiratory parameter changes indicated that both the NCPAP and NIPPV groups experienced improvements in oxygenation and ventilation following MIST.
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Affiliation(s)
- Tzyy-Rong Huang
- Respiratory Therapy Team, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan;
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (S.-T.Y.); (P.-C.S.); (H.-W.C.)
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shu-Ting Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (S.-T.Y.); (P.-C.S.); (H.-W.C.)
| | - Pin-Chun Su
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (S.-T.Y.); (P.-C.S.); (H.-W.C.)
| | - Hao-Wei Chung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (S.-T.Y.); (P.-C.S.); (H.-W.C.)
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Ramanathan R, Biniwale M. Noninvasive Ventilation. Crit Care Nurs Clin North Am 2024; 36:51-67. [PMID: 38296376 DOI: 10.1016/j.cnc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Systematic Reviews and Randomized clinical trials have shown that the use of noninvasive ventilation (NIV) compared to invasive mechanical ventilation reduces the risk of bronchopulmonary dysplasia and or mortality. Most commonly used NIV modes include nasal continuous positive airway pressure, bi-phasic modes, such as, bi-level positive airway pressure, nasal intermittent positive pressure ventilation, high flow nasal cannula, noninvasive neurally adjusted ventilatory assist, and nasal high frequency ventilation are discussed in this review.
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Affiliation(s)
- Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine of USC, Los Angeles General Medical Center, 1200 North State Street, IRD-820, Los Angeles, CA 90033, USA.
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine of USC, Los Angeles General Medical Center, 1200 North State Street, IRD-820, Los Angeles, CA 90033, USA
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Anciuc-Crauciuc M, Cucerea MC, Tripon F, Crauciuc GA, Bănescu CV. Descriptive and Functional Genomics in Neonatal Respiratory Distress Syndrome: From Lung Development to Targeted Therapies. Int J Mol Sci 2024; 25:649. [PMID: 38203821 PMCID: PMC10780183 DOI: 10.3390/ijms25010649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
In this up-to-date study, we first aimed to highlight the genetic and non-genetic factors associated with respiratory distress syndrome (RDS) while also focusing on the genomic aspect of this condition. Secondly, we discuss the treatment options and the progressing therapies based on RNAs or gene therapy. To fulfill this, our study commences with lung organogenesis, a highly orchestrated procedure guided by an intricate network of conserved signaling pathways that ultimately oversee the processes of patterning, growth, and differentiation. Then, our review focuses on the molecular mechanisms contributing to both normal and abnormal lung growth and development and underscores the connections between genetic and non-genetic factors linked to neonatal RDS, with a particular emphasis on the genomic aspects of this condition and their implications for treatment choices and the advancing therapeutic approaches centered around RNAs or gene therapy.
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Affiliation(s)
- Mădălina Anciuc-Crauciuc
- Genetics Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Târgu Mureș, Romania; (M.A.-C.); (C.V.B.)
- Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Târgu Mureș, Romania;
| | - Manuela Camelia Cucerea
- Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Târgu Mureș, Romania;
| | - Florin Tripon
- Genetics Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Târgu Mureș, Romania; (M.A.-C.); (C.V.B.)
| | - George-Andrei Crauciuc
- Genetics Laboratory, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Târgu Mureș, Romania;
| | - Claudia Violeta Bănescu
- Genetics Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Târgu Mureș, Romania; (M.A.-C.); (C.V.B.)
- Genetics Laboratory, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Târgu Mureș, Romania;
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Lin X, Li X, Qulian G, Bai Y, Liu Q. Efficay of high-flow nasal cannula in the paediatric population: A systematic evidence map. J Pediatr Nurs 2023; 73:e327-e363. [PMID: 37838549 DOI: 10.1016/j.pedn.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/30/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
PROBLEM High-flow nasal cannula (HFNC) has been widely used in paediatric medicine as a non-invasive ventilation mode for respiratory support. However, the differences in its efficacy across different diseases and intervention types remain poorly understood. ELIGIBILITY CRITERIA An extensive literature search was performed across multiple academic databases to investigate the systematic reviews and meta-analyses of HFNC. SAMPLE This study included 35 systematic reviews and meta-analyses, which collectively examined 355 randomised controlled trials and assessed 51 outcome indicators. RESULTS The findings suggest that the existing clinical research evidence predominantly supports the therapeutic efficacy of HFNC. Notably, there is a significant focus on treating acute lower respiratory infection, hypoxaemia, bronchiolitis, and respiratory distress syndrome following extubation. However, concerning the respiratory status, the existing clinical research evidence mainly demonstrates the therapeutic benefits in post-extubation respiratory support and primary respiratory support. CONCLUSIONS The research on HFNC has witnessed significant expansion, primarily focusing on respiratory disorders, post-extubation respiratory support, conscious sedation, and related fields. The evidence mapping provides a systematic and comprehensive overview of the available evidence on HFNC therapy in paediatric patients. IMPLICATIONS This study systematically and comprehensively assessed the clinical subjects and populations involved in HFNC therapy. Notably, this study analyzed the trends, current status, and evidence gaps of research, and furnished decision-makers and relevant researchers with a more comprehensive reference basis.
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Affiliation(s)
- Xi Lin
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan 646000, PR China; Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Xiaoqin Li
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China
| | - Guo Qulian
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan 646000, PR China
| | - Yongqi Bai
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
| | - Qin Liu
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China.
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Zhou R, Xiong T, Tang J, Huang Y, Liu W, Zhu J, Chen C, Gong L, Tian K, Wang A, Mu D. High-flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP) vs nasal intermittent positive pressure ventilation as primary respiratory support in infants of ≥ 32 weeks gestational age (GA): study protocol for a three-arm multi-center randomized controlled trial. Trials 2023; 24:647. [PMID: 37803402 PMCID: PMC10557210 DOI: 10.1186/s13063-023-07665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Health problems in neonates with gestational age (GA) ≥ 32 weeks remain a major medical concern. Respiratory distress (RD) is one of the common reasons for admission of neonates with GA ≥ 32 weeks. Noninvasive ventilation (NIV) represents a crucial approach to treat RD, and currently, the most used NIV modes in neonatal intensive care unit include high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and nasal intermittent positive pressure ventilation. Although extensive evidence supports the use of NIPPV in neonates with a GA < 32 weeks, limited data exist regarding its effectiveness in neonates with GA ≥ 32 weeks. Therefore, the aim of this study is to compare the clinical efficacy of HFNC, CPAP, and NIPPV as primary NIV in neonates with GA ≥ 32 weeks who experience RD. METHODS This trial is designed as an assessor-blinded, three-arm, multi-center, parallel, randomized controlled trial, conducted in neonates ≥ 32 weeks' GA requiring primary NIV in the first 24 h of life. The neonates will be randomly assigned to one of three groups: HFNC, CPAP or NIPPV group. The effectiveness, safety and comfort of NIV will be evaluated. The primary outcome is the occurrence of treatment failure within 72 h after enrollment. Secondary outcomes include death before discharge, surfactant treatment within 72 h after randomization, duration of both noninvasive and invasive mechanical ventilation, duration of oxygen therapy, bronchopulmonary dysplasia, time to achieve full enteral nutrition, necrotizing enterocolitis, duration of admission, cost of admission, air leak syndrome, nasal trauma, and comfort score. DISCUSSION Currently, there is a paucity of data regarding the utilization of NIPPV in neonates with GA ≥ 32 weeks. This study will provide clinical evidence for the development of respiratory treatment strategies in neonates at GA ≥ 32 weeks with RD, with the aim of minimizing the incidence of tracheal intubation and reducing the complications associated with NIV. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2300069192. Registered on March 9, 2023, https://www.chictr.org.cn/showproj.html?proj=171491 .
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Affiliation(s)
- Rong Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China.
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Yi Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Wenli Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Jun Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Chao Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Lingyue Gong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Ke Tian
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Aoyu Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
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Sahni M, Bhandari V. Invasive and non-invasive ventilatory strategies for early and evolving bronchopulmonary dysplasia. Semin Perinatol 2023; 47:151815. [PMID: 37775369 DOI: 10.1016/j.semperi.2023.151815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
In the age of surfactant and antenatal steroids, neonatal care has improved outcomes of preterm infants dramatically. Since the early 2000's neonatologists have strived to decrease bronchopulmonary dysplasia (BPD) by decreasing ventilator-associated lung injury and utilizing many novel modes of non-invasive respiratory support. After the initial success with nasal continuous positive airway pressure, it was established that discontinuing invasive ventilation early in favor of non-invasive respiratory support is the most effective way to reduce the incidence of BPD. In this review, we discuss the management of the preterm lung from the time of delivery, through the phases of respiratory distress syndrome (early BPD) and then evolving BPD. The goal remains to optimize respiratory support of the preterm lung while minimizing ventilator-associated lung injury and oxygen toxicity. A multidisciplinary approach involving the medical team and family is quintessential in reaching this goal and involves adequate respiratory support, optimizing nutrition and fluid balance as well as preventing infections.
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Affiliation(s)
- Mitali Sahni
- Pediatrix Medical Group, Sunrise Children's Hospital, Las Vegas, NV, United States; University of Nevada, Las Vegas, NV, United States
| | - Vineet Bhandari
- Neonatology Research Laboratory (Room #206), Education and Research Building, Cooper University Hospital, Camden, NJ, United States; The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, Camden, NJ, United States.
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12
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Gaertner VD, Rüegger CM. Optimising success of neonatal extubation: Respiratory support. Semin Fetal Neonatal Med 2023; 28:101491. [PMID: 37993322 DOI: 10.1016/j.siny.2023.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
In this review, we examine lung physiology before, during and after neonatal extubation and propose a three-phase model for the extubation procedure. We perform meta-analyses to compare different modes of non-invasive respiratory support after neonatal extubation and based on the findings, the following clinical recommendations are made.
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Affiliation(s)
- Vincent D Gaertner
- Newborn Research, Department of Neonatology, University Hospital and University of Zürich, Zürich, Switzerland; Department of Neonatology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Christoph M Rüegger
- Newborn Research, Department of Neonatology, University Hospital and University of Zürich, Zürich, Switzerland.
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13
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Huang Y, Zhao J, Hua X, Luo K, Shi Y, Lin Z, Tang J, Feng Z, Mu D. Guidelines for high-flow nasal cannula oxygen therapy in neonates (2022). J Evid Based Med 2023; 16:394-413. [PMID: 37674304 DOI: 10.1111/jebm.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
High-flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to setup, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The guidelines were formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence-based medicine experts. We have proposed 24 recommendations for 9 key questions. The guidelines aim to be a source of evidence and reference of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.
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Affiliation(s)
- Yi Huang
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
| | - Jing Zhao
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Xintian Hua
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Keren Luo
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Zhenlang Lin
- Department of Neonatology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Jun Tang
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Zhichun Feng
- Department of Neonatology, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, P.R. China
| | - Dezhi Mu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
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14
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Lavizzari A, Zannin E, Klotz D, Dassios T, Roehr CC. State of the art on neonatal noninvasive respiratory support: How physiological and technological principles explain the clinical outcomes. Pediatr Pulmonol 2023; 58:2442-2455. [PMID: 37378417 DOI: 10.1002/ppul.26561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/26/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
Noninvasive respiratory support has gained significant popularity in neonatal units because of its potential to reduce lung injury associated with invasive mechanical ventilation. To minimize lung injury, clinicians aim to apply for noninvasive respiratory support as early as possible. However, the physiological background and the technology behind such support modes are not always clear, and many open questions remain regarding the indications of use and clinical outcomes. This narrative review discusses the currently available evidence for various noninvasive respiratory support modes applied in Neonatal Medicine in terms of physiological effects and indications. Reviewed modes include nasal continuous positive airway pressure, nasal high-flow therapy, noninvasive high-frequency oscillatory ventilation, nasal intermittent positive pressure ventilation (NIPPV), synchronized NIPPV and noninvasive neurally adjusted ventilatory assist. To enhance clinicians' awareness of each support mode's strengths and limitations, we summarize technical features related to the functioning mechanisms of devices and the physical properties of the interfaces commonly used for providing noninvasive respiratory support to neonates. We finally address areas of current controversy and suggest possible areas of research for implementing noninvasive respiratory support in neonatal intensive care units.
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Affiliation(s)
- Anna Lavizzari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Emanuela Zannin
- Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - Daniel Klotz
- Center for Pediatrics, Division of Neonatology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Theodore Dassios
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Charles C Roehr
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
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15
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林 梅, 张 雪, 王 亚, 朱 晓, 薛 江. [Interpretation of the key updates in the 2022 European guideline on the management of neonatal respiratory distress syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:779-784. [PMID: 37668023 PMCID: PMC10484088 DOI: 10.7499/j.issn.1008-8830.2303046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 09/06/2023]
Abstract
With the deepening of clinical research, the management of neonatal respiratory distress syndrome (RDS) needs to be optimized and improved. This article aims to introduce the 2022 European guideline on the management of neonatal RDS, focusing on its key updates. The guide has optimized the management of risk prediction for preterm birth, maternal referral, application of prenatal corticosteroids, application of lung protective ventilation strategies, and general care for infants with RDS. The guideline is mainly applicable to the management of RDS in neonates with gestational age greater than 24 weeks.
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16
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Lemyre B, Deguise MO, Benson P, Kirpalani H, Ekhaguere OA, Davis PG. Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants. Cochrane Database Syst Rev 2023; 7:CD005384. [PMID: 37466143 PMCID: PMC10355255 DOI: 10.1002/14651858.cd005384.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Nasal continuous positive airway pressure (NCPAP) is a strategy to maintain positive airway pressure throughout the respiratory cycle through the application of a bias flow of respiratory gas to an apparatus attached to the nose. Early treatment with NCPAP is associated with decreased risk of mechanical ventilation exposure and might reduce chronic lung disease. Nasal intermittent positive pressure ventilation (NIPPV) is a form of noninvasive ventilation delivered through the same nasal interface during which patients are exposed to short inflations, along with background end-expiratory pressure. OBJECTIVES To examine the risks and benefits of early (within the first six hours after birth) NIPPV versus early NCPAP for preterm infants at risk of or with respiratory distress syndrome (RDS). Primary endpoints are respiratory failure and the need for intubated ventilatory support during the first week of life. Secondary endpoints include the incidence of mortality, chronic lung disease (CLD) (oxygen therapy at 36 weeks' postmenstrual age), pneumothorax, duration of respiratory support, duration of oxygen therapy, and intraventricular hemorrhage (IVH). SEARCH METHODS Searches were conducted in January 2023 in CENTRAL, MEDLINE, Embase, Web of Science, and Dissertation Abstracts. The reference lists of related systematic reviews and of studies selected for inclusion were also searched. SELECTION CRITERIA We considered all randomized and quasi-randomized controlled trials. Eligible studies compared NIPPV versus NCPAP treatment, starting within six hours after birth in preterm infants (< 37 weeks' gestational age (GA)). DATA COLLECTION AND ANALYSIS We collected and analyzed data using the recommendations of the Cochrane Neonatal Review Group. MAIN RESULTS We included 17 trials, enrolling 1958 infants in this review. NIPPV likely reduces the rate of respiratory failure (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.54 to 0.78; risk difference (RD) -0.08, 95% CI -0.12 to -0.05; 17 RCTs, 1958 infants; moderate-certainty evidence) and needing endotracheal tube ventilation (RR 0.67, 95% CI 0.56 to 0.81; RD -0.07, 95% CI -0.11 to -0.04; 16 RCTs; 1848 infants; moderate-certainty evidence) amongst infants treated with early NIPPV compared with early NCPAP. The meta-analysis demonstrated that NIPPV may reduce the risk of developing CLD compared to CPAP (RR 0.70, 95% CI 0.52 to 0.92; 12 RCTs, 1284 infants; low-certainty evidence) slightly. NIPPV may result in little to no difference in mortality (RR 0.82, 95% CI 0.62 to 1.10; 17 RCTs; 1958 infants; I2 of 0%; low-certainty evidence), the incidence of pneumothorax (RR 0.92, 95% CI 0.60 to 1.41; 16 RCTs; 1674 infants; I2 of 0%; low-certainty evidence), and rates of severe IVH (RR 0.98, 95% CI 0.53 to 1.79; 8 RCTs; 977 infants; I2 of 0%; low-certainty evidence). AUTHORS' CONCLUSIONS When applied within six hours after birth, NIPPV likely reduces the risk of respiratory failure and the need for intubation and endotracheal tube ventilation in very preterm infants (GA 28 weeks and above) with respiratory distress syndrome or at risk for RDS. It may also decrease the rate of CLD slightly. However, most trials enrolled infants with a gestational age of approximately 28 to 32 weeks with an overall mean gestational age of around 30 weeks. As such, the results of this review may not apply to extremely preterm infants that are most at risk of needing mechanical ventilation or developing CLD. Additional studies are needed to confirm these results and to assess the safety of NIPPV compared with NCPAP alone in a larger patient population.
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Affiliation(s)
- Brigitte Lemyre
- Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Marc-Olivier Deguise
- Dept. of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paige Benson
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Osayame A Ekhaguere
- Division of Neonatal-Perinatal Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Australia
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17
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Ishigami AC, Meneses J, Alves JG, Carvalho J, Cavalcanti E, Bhandari V. Nasal intermittent positive pressure ventilation as a rescue therapy after nasal continuous positive airway pressure failure in infants with respiratory distress syndrome. J Perinatol 2023; 43:311-316. [PMID: 36631566 DOI: 10.1038/s41372-023-01600-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/11/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Evaluate whether nasal intermittent positive-pressure ventilation (NIPPV) as rescue therapy after initial nasal continuous positive airway (NCPAP) failure reduces need for invasive mechanical ventilation (IMV) in infants with respiratory distress syndrome (RDS). DESIGN Retrospective cohort involving 156 preterm infants who failed initial NCPAP and were then submitted to NIPPV rescue therapy and classified into NIPPV success or failure, according to need for IMV. RESULT Of all infants included, 85 (54.5%) were successfully rescued with NIPPV while 71 (45.5%) failed. The NIPPV success group had significantly lower rates of bronchopulmonary dysplasia, peri/intraventricular hemorrhage, patent ductus arteriosus and greater survival without morbidities (all p ≤ 0.01). Infants who failed NIPPV had earlier initial NCPAP failure (p = 0.09). In final logistic regression model, birthweight ≤1000 g and need for surfactant remained significant factors for NIPPV failure. CONCLUSION NIPPV rescue therapy reduced the need for IMV in infants that failed NCPAP and was associated with better outcomes.
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Affiliation(s)
- Ana Catarina Ishigami
- Division of Neonatology, Instituto de Medicina Integral Professor Fernando Figueira, IMIP, Recife, Brazil
| | - Jucille Meneses
- Division of Neonatology, Instituto de Medicina Integral Professor Fernando Figueira, IMIP, Recife, Brazil.
| | - João Guilherme Alves
- Division of Neonatology, Instituto de Medicina Integral Professor Fernando Figueira, IMIP, Recife, Brazil
| | - Juliana Carvalho
- Division of Neonatology, Instituto de Medicina Integral Professor Fernando Figueira, IMIP, Recife, Brazil
| | - Emídio Cavalcanti
- Division of Neonatology, Instituto de Medicina Integral Professor Fernando Figueira, IMIP, Recife, Brazil
| | - Vineet Bhandari
- Division of Neonatology, The Children's Regional Hospital at Cooper, Camden, NJ, USA.,Cooper Medical School of Rowan University, Camden, NJ, USA
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18
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Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2023; 120:3-23. [PMID: 36863329 PMCID: PMC10064400 DOI: 10.1159/000528914] [Citation(s) in RCA: 115] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023]
Abstract
Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).
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Affiliation(s)
- David G. Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
| | - Virgilio P. Carnielli
- Department of Neonatology, University Polytechnic Della Marche, University Hospital Ancona, Ancona, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mikko Hallman
- Department of Children and Adolescents, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria
| | - Eren Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Arjan te Pas
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Charles C. Roehr
- Faculty of Health Sciences, University of Bristol, UK and National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Christian P. Speer
- Department of Pediatrics, University Children's Hospital, Wuerzburg, Germany
| | - Maximo Vento
- Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gerry H.A. Visser
- Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - Henry L. Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, UK
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19
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Ultrasonographic assessment of diaphragmatic function in preterm infants on non-invasive neurally adjusted ventilatory assist (NIV-NAVA) compared to nasal intermittent positive-pressure ventilation (NIPPV): a prospective observational study. Eur J Pediatr 2023; 182:731-739. [PMID: 36459227 PMCID: PMC9717554 DOI: 10.1007/s00431-022-04738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/19/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
NIV-NAVA mode for respiratory support in preterm infants is not well-studied. This study aimed to describe the diaphragmatic function, diaphragmatic excursion (DE), and thickness fraction (DTF), in preterm infants < 30 weeks' gestation supported by NIV-NAVA compared to NIPPV using bedside ultrasonography. In this consecutive prospective study, DE, diaphragmatic thickness at end of expiration (DTexp), end of inspiration (DTins), and DTF were assessed using bedside ultrasound. Lung aeration evaluation using lung ultrasound score (LUS) was performed for the two groups. Diaphragmatic measurements and LUS were compared for the 2 groups (NIV-NAVA group versus NIPPV group). Statistical analyses were conducted using the SPSS software version 22. Out of 70 infants evaluated, 40 were enrolled. Twenty infants were on NIV-NAVA and 20 infants on NIPPV with a mean [SD] study age of 25.7 [0.9] weeks and 25.1 [1.4] weeks respectively (p = 0.15). Baseline characteristics and respiratory parameters at the time of the scan showed no significant difference between groups. DE was significantly higher in NIV-NAVA with a mean SD of 4.7 (1.5) mm versus 3.5 (0.9) mm in NIPPV, p = 0.007. Additionally, the mean (SD) of DTF for the NIV-NAVA group was 81.6 (30) % vs 78.2 (27) % for the NIPPV group [p = 0.71]. Both groups showed relatively high LUS but no significant difference between groups [12.8 (2.6) vs 12.6 (2.6), p = 0.8]. Conclusion: Preterm infants managed with NIV-NAVA showed significantly higher DE compared to those managed on NIPPV. This study raises the hypothesis that NIV-NAVA could potentially improve diaphragmatic function due to its synchronization with patients' own breathing. Longitudinal studies to assess diaphragmatic function over time are needed. Trial registry: Clinicaltrials.gov (NCT05079412). Date of registration September 30, 2021. What is Known: • NIV-NAVA utilizes diaphragmatic electrical activity to provide synchronized breathing support. • Evidence for the effect of NIV-NAVA on diaphragmatic thickness fraction (DTF) and excursion (DE) is limited. What is New: • Ultrasonographic assessment of diaphragmatic function (DTF and DE) is feasible. • In preterm infants, DE was significantly higher in infants supported with NIV-NAVA compared to those supported with NIPPV.
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20
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Nasal Interfaces to Deliver NIPPV-Do Masks Perform Better? Indian J Pediatr 2022; 89:1173-1174. [PMID: 36112266 DOI: 10.1007/s12098-022-04359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022]
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21
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Mahmoud RA, Schmalisch G, Oswal A, Christoph Roehr C. Non-invasive ventilatory support in neonates: An evidence-based update. Paediatr Respir Rev 2022; 44:11-18. [PMID: 36428196 DOI: 10.1016/j.prrv.2022.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022]
Abstract
Non-invasive ventilatory support (NIV) is considered the gold standard in the care of preterm infants with respiratory distress syndrome (RDS). NIV from birth is superior to mechanical ventilation (MV) for the prevention of death or bronchopulmonary dysplasia (BPD), with a number needed to treat between 25 and 35. Various methods of NIV are available, some of them extensively researched and with well proven efficacy, whilst others are needing further research. Nasal continuous positive airway pressure (nCPAP) has replaced routine invasive mechanical ventilation (MV) for the initial stabilization and the treatment of RDS. Choosing the most suitable form of NIV and the most appropriate patient interface depends on several factors, including gestational age, underlying lung pathophysiology and the local facilities. In this review, we present the currently available evidence on NIV as primary ventilatory support to preventing intubation and for secondary ventilatory support, following extubation. We review nCPAP, nasal high-flow cannula, nasal intermittent positive airway pressure ventilation, bi-level positive airway pressure, nasal high-frequency oscillatory ventilation and nasal neurally adjusted ventilatory assist modes. We also discuss most suitable NIV devices and patient interfaces during resuscitation of the newborn in the delivery room.
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Affiliation(s)
- Ramadan A Mahmoud
- Department of Pediatrics, Sohag Faculty of Medicine, Sohag University, Egypt; Department of Neonatology, Maternity and Child Hospital, Al-kharj, Saudi Arabia
| | - Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Abhishek Oswal
- Newborn Care, Southmead Hospital, North Bristol Trust, Bristol, UK
| | - Charles Christoph Roehr
- Newborn Care, Southmead Hospital, North Bristol Trust, Bristol, UK; University of Bristol, Faculty of Medicine, Bristol, UK.
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22
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Rub DM, Sivieri EM, Abbasi S, Sieberlich W, Eichenwald EC. Comparison of nasal intermittent positive pressure ventilation and bubble CPAP with an in-line high-frequency interrupter in a premature infant lung model. Pediatr Pulmonol 2022; 57:2356-2362. [PMID: 35722805 DOI: 10.1002/ppul.26039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Noninvasive ventilation has become a staple in the care of premature infants. However, failure rates continue to be high in this population. Modifications to noninvasive support, such as nasal intermittent positive pressure ventilation (NIPPV), are used clinically to reduce such failure. Previous in vitro studies have shown improved CO2 clearance when superimposing high-frequency oscillations onto bubble continuous positive airway pressure (BCPAP). OBJECTIVE To compare the CO2 clearance of NIPPV to BCPAP with an in-line high-frequency interrupter (HFI) in a premature infant lung model. METHODS A premature infant lung model was connected to either a Dräger VN500 for delivery of NIPPV or a BCPAP device with superimposed high-frequency oscillations generated by an in-line HFI. Change in end-tidal CO2 (ETCO2 ) and mean airway pressure at the simulated trachea were measured and compared for both noninvasive modalities. RESULTS Superimposing HF oscillations onto BCPAP with an in-line HFI resulted in improved CO2 clearance relative to BCPAP alone for all tested oscillation frequencies at all CPAP levels (p < 0.001). NIPPV also resulted in improved CO2 clearance relative to nasal CPAP (NCPAP) alone (p < 0.001). Among the tested settings, BCPAP with an in-line HFI resulted in decreased ETCO2 relative to BCPAP ranging from -14% to -36%, while NIPPV resulted in decreased ETCO2 relative to NCPAP ranging from -2% to -12%. CONCLUSION Superimposing high-frequency oscillations onto BCPAP using a novel in-line HFI was found to be more effective at clearing CO2 than NIPPV in a premature infant lung model.
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Affiliation(s)
- David M Rub
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emidio M Sivieri
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Soraya Abbasi
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - William Sieberlich
- CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Eric C Eichenwald
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
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23
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Value of Serum miR-34a and Ang-1 in Severity Evaluation and Prognosis of Neonatal Respiratory Distress Syndrome. Emerg Med Int 2022; 2022:5480026. [PMID: 36186528 PMCID: PMC9519325 DOI: 10.1155/2022/5480026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022] Open
Abstract
Methods A total of 96 neonates with RDS admitted to the hospital from February 2020 to April 2021 were selected as the research subjects. According to the neonatal critical illness score, the subjects were divided into non-critical group (n = 50), critical group (n = 27), and extremely critical group (n = 19). According to survival status, the subjects were divided into survival group (n = 76) and death group (n = 20). Serum miR-34a and Ang-1 levels and NCIS were compared between RDS neonates with different severity and prognosis. The predictive value of serum miR-34a, Ang-1, and NCIS for death was analyzed using the receiver operating characteristic (ROC) curve. Results Serum miR-34a and Ang-1 levels and NCIS were significantly different in the 3 groups (P < 0.05). Serum miR-34a level decreased in order, while serum Ang-1 level and NCIS increased in order from the extremely critical group, the critical group to the non-critical group (P < 0.05). The survival group had lower serum miR-34a level and higher Ang-1 level and NCIS than the death group (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) values of serum miR-34a, Ang-1, and NCIS to predict death of RDS neonates were 0.745, 0.7667, and 0.736. The cutoff values were 1.175, 6.815 ng/mL, and 85 points. The AUC of joint prediction with the three was 0.924, significantly larger than that of each index. The sensitivity and specificity were 94.70% and 90.00%. Conclusion Serum miR-34a, Ang-1, and NCIS are closely related to the severity and prognosis of neonatal RDS. Combined detection of the three is helpful for prognosis of neonatal RDS.
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24
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Boel L, Hixson T, Brown L, Sage J, Kotecha S, Chakraborty M. Non-invasive respiratory support in preterm infants. Paediatr Respir Rev 2022; 43:53-59. [PMID: 35562288 DOI: 10.1016/j.prrv.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 12/25/2022]
Abstract
Survival of preterm infants has increased steadily over recent decades, primarily due to improved outcomes for those born before 28 weeks of gestation. However, this has not been matched by similar improvements in longer-term morbidity. One of the key long-term sequelae of preterm birth remains bronchopulmonary dysplasia (also called chronic lung disease of prematurity), contributed primarily by the effect of early pulmonary inflammation superimposed on immature lungs. Non-invasive modes of respiratory support have been rapidly introduced providing modest success in reducing the incidence of bronchopulmonary dysplasia when compared with invasive mechanical ventilation, and improved clinical practice has been reported from population-based studies. We present a comprehensive review of the key modes of non-invasive respiratory support currently used in preterm infants, including their mechanisms of action and evidence of benefit from clinical trials.
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Affiliation(s)
- Lieve Boel
- Neonatal Intensive Care Unit, Queen Alexandra Hospital, Portsmouth, UK
| | - Thomas Hixson
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Lisa Brown
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Jayne Sage
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK; Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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25
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Diala UM, Toma BO, Shwe DD, Ofakunrin AOD, Diala OO, John C. An assessment of improved outcomes using low-cost bubble CPAP in very low birthweight neonates in a Nigerian tertiary hospital. Trop Doct 2022; 52:503-509. [PMID: 35950793 DOI: 10.1177/00494755221107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Respiratory distress contributes to the high burden of preterm mortality globally. The aim of our study was to evaluate the use of low-cost Bubble Continuous Positive Airway Pressure devices for treating respiratory distress and their outcomes in preterm infants weighing <1500g. Data was extracted from admission records of 211 infants over two distinct 4-year periods before and after introduction of bCPAP. With survival rates of 26.7% and 61.8% in the pre and post bCPAP eras respectively, significantly improved outcomes were found.
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Affiliation(s)
- Udochukwu M Diala
- Department of Paediatrics, 100570University of Jos, Jos, Plateau State, Nigeria.,Department of Paediatrics, 291849Jos University Teaching Hospital, Jos, Plateau Sate, Nigeria
| | - Bose O Toma
- Department of Paediatrics, 100570University of Jos, Jos, Plateau State, Nigeria.,Department of Paediatrics, 291849Jos University Teaching Hospital, Jos, Plateau Sate, Nigeria
| | - David D Shwe
- Department of Paediatrics, 100570University of Jos, Jos, Plateau State, Nigeria.,Department of Paediatrics, 291849Jos University Teaching Hospital, Jos, Plateau Sate, Nigeria
| | - Akinyemi O D Ofakunrin
- Department of Paediatrics, 100570University of Jos, Jos, Plateau State, Nigeria.,Department of Paediatrics, 291849Jos University Teaching Hospital, Jos, Plateau Sate, Nigeria
| | - Olubunmi O Diala
- Department of Family Medicine, 291849Jos University Teaching Hospital, Plateau State, Nigeria
| | - Collins John
- Department of Paediatrics, 100570University of Jos, Jos, Plateau State, Nigeria.,Department of Paediatrics, 291849Jos University Teaching Hospital, Jos, Plateau Sate, Nigeria
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26
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Perri A, Fattore S, D’Andrea V, Sbordone A, Patti ML, Nobile S, Tirone C, Giordano L, Tana M, Priolo F, Serrao F, Riccardi R, Prontera G, Vento G. Lowering of the Neonatal Lung Ultrasonography Score after nCPAP Positioning in Neonates over 32 Weeks of Gestational Age with Neonatal Respiratory Distress. Diagnostics (Basel) 2022; 12:diagnostics12081909. [PMID: 36010259 PMCID: PMC9406690 DOI: 10.3390/diagnostics12081909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Respiratory distress (RD) is one of the most common causes of admission to the neonatal intensive care unit. Correct diagnosis and timely intervention are crucial. Lung ultrasonography (LU) is a useful diagnostic tool for the neonatologist in the diagnosis of RD; the neonatal lung ultrasonography score (nLUS) can be used in the diagnostic process, but some authors hypothesise that it is also useful for the management of some neonatal RD. The aim of this study is to analyse the changes in nLUS score before (T0) and after (T1) the start of respiratory support with nasal CPAP in neonates over 32 weeks of age with RD. Thirty-three newborns were enrolled in this retrospective study. LU was performed before and after the start of CPAP. The median nLUS scores at T0 and T1 were 9 (IQR 7−12) and 7 (IQR 4−10), respectively, and showed a significant difference (p < 0.001). The magnitude of reduction in nLUS score, expressed as a percentage, was inversely related to the need for subsequent administration of exogenous surfactant. The study suggests the usefulness of the nLUS score in assessing the response to CPAP in neonates over 32 weeks gestational age.
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Affiliation(s)
- Alessandro Perri
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Simona Fattore
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Vito D’Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154357; Fax: +39-063383211
| | - Annamaria Sbordone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Letizia Patti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Nobile
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Tirone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lucia Giordano
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Milena Tana
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Priolo
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Serrao
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Riccardi
- Neonatal Intensive Care Unit, “San Giovanni Calibita Fatebenefratelli” Hospital, Isola Tiberina, 00186 Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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27
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Wanous AA, Ibrahim J, Vats KR. Neonatal resuscitation. Semin Pediatr Surg 2022; 31:151204. [PMID: 36038213 DOI: 10.1016/j.sempedsurg.2022.151204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Amanda A Wanous
- Division of Newborn Medicine, Department of Pediatrics, Children and Magee Women's Hospital, University of Pittsburgh, 300 Halket Street, PA 12513, United States
| | - John Ibrahim
- Division of Newborn Medicine, Department of Pediatrics, Children and Magee Women's Hospital, University of Pittsburgh, 300 Halket Street, PA 12513, United States
| | - Kalyani R Vats
- Division of Newborn Medicine, Department of Pediatrics, Children and Magee Women's Hospital, University of Pittsburgh, 300 Halket Street, PA 12513, United States.
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28
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Jia CH, Feng ZS, Lin XJ, Cui QL, Han SS, Jin Y, Liu GS, Yang CZ, Ye XT, Dai YH, Liang WY, Ye XZ, Mo J, Ding L, Wu BQ, Chen HX, Li CW, Zhang Z, Rong X, Huang WM, Shen W, Yang BY, Lv JF, Huo LY, Huang HW, Rao HP, Yan WK, Yang Y, Ren XJ, Liu D, Wang FF, Diao SG, Liu XY, You CM, Meng Q, Wang B, Zhang LJ, Huang YG, Ao D, Li WZ, Chen JL, Chen YL, Li W, Chen ZF, Ding YQ, Li XY, Huang YF, Lin NY, Cai YF, Wan ZH, Ban Y, Bai B, Li GH, Yan YX, Wu F. Short term outcomes of extremely low birth weight infants from a multicenter cohort study in Guangdong of China. Sci Rep 2022; 12:11119. [PMID: 35778441 PMCID: PMC9249781 DOI: 10.1038/s41598-022-14432-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 02/05/2023] Open
Abstract
With the increase in extremely low birth weight (ELBW) infants, their outcome attracted worldwide attention. However, in China, the related studies are rare. The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units in Guangdong Province of China during 2008-2017 were analyzed. A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76% to 62.02%. Increased survival is closely related to birth weight (BW), regional economic development, and specialized hospital. The incidence of complications was neonatal respiratory distress syndrome (85.2%), oxygen dependency at 28 days (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days). A total of 768 ELBW infants died after treatment withdrawal, for reasons of economic and/or poor outcome. The number of ELBW infants is increasing in Guangdong Province of China, and the overall survival rate is improving steadily.
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Affiliation(s)
- Chun-Hong Jia
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
- Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, 510150, Guangdong, China
| | - Zhou-Shan Feng
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Xiao-Jun Lin
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Qi-Liang Cui
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Sha-Sha Han
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Ya Jin
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Guo-Sheng Liu
- Department of Neonatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Chuan-Zhong Yang
- Department of Neonatology, Shenzhen Maternal and Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Xiao-Tong Ye
- Department of Neonatology, Shenzhen Maternal and Child Healthcare Hospital, Affiliated Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Yi-Heng Dai
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Wei-Yi Liang
- Department of Neonatology, Foshan Maternal and Child's Hospital, Foshan, 528000, Guangdong, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Jing Mo
- Department of Neonatology, Women and Children Hospital of Guangdong Province, Guangzhou, 510010, Guangdong, China
| | - Lu Ding
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Ben-Qing Wu
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Hong-Xiang Chen
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Chi-Wang Li
- Department of Neonatology, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Zhe Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Xiao Rong
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, 510120, Guangdong, China
| | - Wei-Min Huang
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Wei Shen
- Department of Neonatology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Bing-Yan Yang
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Jun-Feng Lv
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, 528400, Guangdong, China
| | - Le-Ying Huo
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Hui-Wen Huang
- Department of Neonatology, Zhuhai Maternity and Child Health Hospital, Zhuhai, 519001, Guangdong, China
| | - Hong-Ping Rao
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Wen-Kang Yan
- Department of Neonatology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China
| | - Yong Yang
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Xue-Jun Ren
- Department of Neonatology, Dongguan Maternity and Child Health Hospital, Dongguan, 523002, Guangdong, China
| | - Dong Liu
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, Guangdong, China
| | - Fang-Fang Wang
- Department of Neonatology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, Guangdong, China
| | - Shi-Guang Diao
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Xiao-Yan Liu
- Department of Neonatology, Yuebei People's Hospital, Shaoguan, 512026, Guangdong, China
| | - Chu-Ming You
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Qiong Meng
- Department of Neonatology, Guangdong Second Provincial People's Hospital, Guangzhou, 510317, Guangdong, China
| | - Bin Wang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Li-Juan Zhang
- Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Yu-Ge Huang
- Department of Pediatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Dang Ao
- Department of Pediatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Wei-Zhong Li
- Department of Neonatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Jie-Ling Chen
- Department of Neonatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yan-Ling Chen
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Wei Li
- Department of Neonatology, Jinan University Medical College Affiliated Dongguan Hospital, Dongguan, 523900, Guangdong, China
| | - Zhi-Feng Chen
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Yue-Qin Ding
- Department of Pediatrics, Dongguan People's Hospital, Dongguan, 523000, Guangdong, China
| | - Xiao-Yu Li
- Department of Neonatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Yue-Fang Huang
- Department of Neonatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Ni-Yang Lin
- Department of Neonatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yang-Fan Cai
- Department of Neonatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhong-He Wan
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Yi Ban
- Department of Neonatology, Nanhai District People's Hospital of Foshan, Foshan, 528200, Guangdong, China
| | - Bo Bai
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Guang-Hong Li
- Department of Neonatology, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, China
| | - Yue-Xiu Yan
- Department of Pediatrics, The First People's Hospital of Zhaoqing, Zhaoqing, 526020, Guangdong, China
| | - Fan Wu
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China.
- Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, 510150, Guangdong, China.
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29
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Singh S, Ananthan A, Nanavati R. Post-INSURE Administration of Heated Humidified High-Flow Therapy Versus Nasal Continuous Positive Airway Pressure in Preterm Infants More Than 28 Weeks Gestation with Respiratory Distress Syndrome: A Randomized Non-Inferiority Trial. J Trop Pediatr 2022; 68:6649677. [PMID: 35877150 DOI: 10.1093/tropej/fmac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In preterm infants with respiratory distress syndrome (RDS), non-invasive ventilation (NIV) is usually provided using nasal continuous positive airway pressure (NCPAP) or non-invasive mechanical ventilation after surfactant administration by INtubation-SURfactant-Extubation (INSURE) method. Heated humidified high-flow nasal cannula (HHHFNC) is a mode of NIV with advantages of ease of application, less grades of nasal injury and easy handling. This study was done to compare the effectiveness of HHHFNC therapy administration as post-INSURE respiratory support in preterm infants as compared to NCPAP. The primary outcome was to compare the rate of treatment failure within 7 days of randomization to HHHFNC or NCPAP as a post-INSURE ventilatory modality. It was a pilot trial wherein all preterm infants more than 1 kg and more than 28 weeks gestational age with RDS who required surfactant were randomized to receive NCPAP or HHHFNC. Infants with an urgent need for intubation and mechanical ventilation were considered to have treatment failure. Thirty babies were enrolled-15 in each group. Baseline demographic characteristics were comparable. There was no significant difference in the primary outcome of early failure rate, i.e. mechanical ventilation rate within 7 days of starting treatment. There were no significant differences in other outcomes except nasal injury which was significantly lesser in the HHHFNC group. In conclusion, HHHFNC appears to be non-inferior to NCPAP when used in preterm infants more than 28 weeks gestation with RDS as a post-INSURE ventilatory modality.
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Affiliation(s)
- Srijan Singh
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
| | - Anitha Ananthan
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
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30
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Continuing interventions in a quality improvement bundle to reduce bronchopulmonary dysplasia. World J Pediatr 2022; 18:278-282. [PMID: 35179711 DOI: 10.1007/s12519-021-00508-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
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31
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Norman M, Jonsson B, Wallström L, Sindelar R. Respiratory support of infants born at 22-24 weeks of gestational age. Semin Fetal Neonatal Med 2022; 27:101328. [PMID: 35400604 DOI: 10.1016/j.siny.2022.101328] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lung immaturity and acute respiratory failure are the major problems in the care of extremely preterm infants. Most infants with gestational age (GA) 22-24 weeks will need mechanical ventilation and many will depend on some type of respiratory support, invasive and non-invasive for extended periods. There is ongoing gap in knowledge regarding optimal respiratory support and applying strategies that are effective in more mature populations is not easy or even suitable because lung maturation differs in smaller infants. Better strategies on how to avoid lung damage and to promote growth and development of the immature lung are warranted since increased survival is accompanied by increasing rates of bronchopulmonary dysplasia and concerns over long-standing reductions in lung function. This review focuses on some aspects of respiratory care of infants born at 22-24 weeks of GA.
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Affiliation(s)
- Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, S3:03 Norrbacka, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
| | - Baldvin Jonsson
- Department of Neonatal Medicine, S3:03 Norrbacka, Karolinska University Hospital, SE-171 76, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Linda Wallström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Richard Sindelar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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32
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Khare C, Adhisivam B, Gupta A, Vaishnav D, Vishnu Bhat B. Evaluation of T-piece resuscitator in the delivery room management of pre-term neonates with respiratory distress syndrome in resource-limited settings: A pre-post intervention study. Trop Doct 2022; 52:262-269. [PMID: 35243942 DOI: 10.1177/00494755221076942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of our study was to evaluate the impact of the T-piece resuscitator in the delivery room management of pre-term neonates in a resource-limited setting. We compared the incidence rates of delivery room intubation, surfactant replacement therapy, pulmonary air leak syndrome, and pre-term very low birth weight infant mortality, before and after T-piece use. Bi-monthly neonatal resuscitation training sessions were conducted for healthcare providers during the study period. We emphasized hands-on experience with the T-piece resuscitator and delivery room early respiratory care practices during the post-intervention epoch. Our pre- and post-intervention data recorded statistically significant decline in delivery room intubations, a 32% decrease in surfactant replacement therapy, and a 57% decrease in air leaks in pre-term neonates. However, the use of T-piece resuscitator did not have a statistically significant effect on pre-term very low birth weight infant mortality.
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Affiliation(s)
- Chetan Khare
- Department of Neonatology, 390706All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.,Department of Neonatology, 29988Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Bethou Adhisivam
- Department of Neonatology, 29988Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Avantika Gupta
- Department of Obstetrics and Gynaecology, 534693All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Dheeraj Vaishnav
- Department of Neonatology, 155196Geetanjali Institute of Medical Sciences, Udaipur, Rajasthan, India
| | - Ballambattu Vishnu Bhat
- Department of Neonatology, 29988Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.,Department of Paediatrics, 75452Aarupadai Veedu Medical College, Puducherry, India
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Sand L, Szatkowski L, Kwok TC, Sharkey D, Todd DA, Budge H, Ojha S. Observational cohort study of changing trends in non-invasive ventilation in very preterm infants and associations with clinical outcomes. Arch Dis Child Fetal Neonatal Ed 2022; 107:150-155. [PMID: 34413093 DOI: 10.1136/archdischild-2021-322390] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the change in non-invasive ventilation (NIV) use over time in infants born at <32 weeks' gestation and the associated clinical outcomes. STUDY DESIGN Retrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017. RESULTS In 56 537 infants, NIV use increased significantly between 2010 and 2017 (continuous positive airway pressure (CPAP) from 68.5% to 80.2% in 2017 and high flow nasal cannula (HFNC) from 14% to 68%, respectively) (p<0.001)). Use of NIV as the initial mode of respiratory support also increased (CPAP, 21.5%-28.0%; HFNC, 1%-7% (p<0.001)).HFNC was used earlier, and for longer, in those who received CPAP or mechanical ventilation. HFNC use was associated with decreased odds of death before discharge (adjusted OR (aOR) 0.19, 95% CI 0.17 to 0.22). Infants receiving CPAP but no HFNC died at an earlier median chronological age: CPAP group, 22 (IQR 10-39) days; HFNC group 40 (20-76) days (p<0.001). Among survivors, HFNC use was associated with increased odds of bronchopulmonary dysplasia (BPD) (aOR 2.98, 95% CI 2.81 to 3.15) and other adverse outcomes. CONCLUSIONS NIV use is increasing, particularly as initial respiratory support. HFNC use has increased significantly with a sevenfold increase soon after birth which was associated with higher rates of BPD. As more infants survive with BPD, we need robust clinical evidence, to improve outcomes with the use of NIV as initial and ongoing respiratory support.
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Affiliation(s)
- Laura Sand
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lisa Szatkowski
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - T'ng Chang Kwok
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - David A Todd
- Neonatal Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Helen Budge
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shalini Ojha
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK .,Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Avila-Alvarez A, Zozaya C, Pértega-Diaz S, Sanchez-Luna M, Iriondo-Sanz M, Elorza MD, García-Muñoz Rodrigo F. Temporal trends in respiratory care and bronchopulmonary dysplasia in very preterm infants over a 10-year period in Spain. Arch Dis Child Fetal Neonatal Ed 2022; 107:143-149. [PMID: 34321246 DOI: 10.1136/archdischild-2021-322402] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate trends in respiratory care practices and bronchopulmonary dysplasia (BPD) among very preterm infants born in Spain between 2010 and 2019. STUDY DESIGN This was a retrospective cohort study of data obtained from a national population-based database (SEN1500 network). Changes in respiratory care and BPD-free survival of infants with gestational age (GA) of 230-316 weeks and <1500 g were assessed over two 5-year periods. Temporal trends were examined by joinpoint and Poisson regression models and expressed as the annual per cent change and adjusted relative risk (RR) for the change per year. RESULTS A total of 17 952 infants were included. In the second period, infants were less frequently intubated in the delivery room and during neonatal intensive care unit stay. This corresponded with an increase in use of non-invasive ventilation techniques. There were no significant differences between the periods in BPD-free survival or survival without moderate-to-severe BPD. After adjusting for covariates, the RR for the change per year was significant for the following variables: never intubated (RR 1.03, 95% CI 1.02 to 1.04); intubation in the delivery room (RR 0.98, 95% CI 0.97 to 0.99); use of nasal intermittent positive pressure ventilation (RR 1.08, 95% CI 1.05 to 1.11); and BPD-free survival (only in the group with the lowest GA; RR 0.98, 95% CI 0.97 to 0.99). CONCLUSION Our findings reveal significant changes in respiratory care practices between 2009 and 2019. Despite an increase in use of non-invasive respiratory strategies, BPD-free survival did not improve and even worsened in the group with the lowest GA (230-256).
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Affiliation(s)
| | - Carlos Zozaya
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sonia Pértega-Diaz
- Research Support Unit, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Manuel Sanchez-Luna
- Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Martin Iriondo-Sanz
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal, Hospital Sant Joan de Déu-Hospital, Barcelona University, Barcelona, Spain
| | | | - Fermín García-Muñoz Rodrigo
- Division of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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Vyas-Read S, Logan JW, Cuna AC, Machry J, Leeman KT, Rose RS, Mikhael M, Wymore E, Ibrahim JW, DiGeronimo RJ, Yallapragada S, Haberman BE, Padula MA, Porta NF, Murthy K, Nelin LD, Coghill CH, Zaniletti I, Savani RC, Truog W, Engle WA, Lagatta JM. A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children's Hospitals Neonatal Consortium Severe BPD Group. J Perinatol 2022; 42:58-64. [PMID: 34354227 PMCID: PMC8340076 DOI: 10.1038/s41372-021-01178-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare three bronchopulmonary dysplasia (BPD) definitions against hospital outcomes in a referral-based population. STUDY DESIGN Data from the Children's Hospitals Neonatal Consortium were classified by 2018 NICHD, 2019 NRN, and Canadian Neonatal Network (CNN) BPD definitions. Multivariable models evaluated the associations between BPD severity and death, tracheostomy, or length of stay, relative to No BPD references. RESULTS Mortality was highest in 2019 NRN Grade 3 infants (aOR 225), followed by 2018 NICHD Grade 3 (aOR 145). Infants with lower BPD grades rarely died (<1%), but Grade 2 infants had aOR 7-21-fold higher for death and 23-56-fold higher for tracheostomy. CONCLUSIONS Definitions with 3 BPD grades had better discrimination and Grade 3 2019 NRN had the strongest association with outcomes. No/Grade 1 infants rarely had severe outcomes, but Grade 2 infants were at risk. These data may be useful for counseling families and determining therapies for infants with BPD.
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Affiliation(s)
- Shilpa Vyas-Read
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - J. Wells Logan
- grid.261331.40000 0001 2285 7943The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
| | - Alain C. Cuna
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City and Children’s Mercy Hospital, Kansas, MO USA
| | - Joana Machry
- grid.21107.350000 0001 2171 9311Johns Hopkins University and Johns Hopkins All Children’s Hospital, Baltimore, MD USA
| | - Kristin T. Leeman
- grid.2515.30000 0004 0378 8438Harvard University and Boston Children’s Hospital, Cambridge, MA USA
| | - Rebecca S. Rose
- grid.257410.50000 0004 0413 3089Indiana University and Riley Children’s Hospital, Bloomington, IN USA
| | - Michel Mikhael
- grid.19006.3e0000 0000 9632 6718University of California, Irvine and Children’s Hospital of Orange County, Los Angeles, CA USA
| | - Erica Wymore
- grid.266190.a0000000096214564University of Colorado and Children’s Hospital Colorado, Boulder, CO USA
| | - John W. Ibrahim
- grid.239553.b0000 0000 9753 0008University of Pittsburgh and Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Robert J. DiGeronimo
- grid.34477.330000000122986657University of Washington, Seattle and Seattle Children’s Hospital, Seattle, WA USA
| | - Sushmita Yallapragada
- University of Texas, Southwestern and Children’s Medical Center of Dallas, Dallas, TX USA
| | - Beth E. Haberman
- grid.24827.3b0000 0001 2179 9593University of Cincinnati and Cincinnati Children’s Hospital, Cincinnati, OH USA
| | - Michael A. Padula
- grid.239552.a0000 0001 0680 8770University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Nicolas F. Porta
- grid.413808.60000 0004 0388 2248Northwestern University and Ann & Robert H Lurie Children’s Hospital, Evanston, IL USA
| | - Karna Murthy
- grid.413808.60000 0004 0388 2248Northwestern University and Ann & Robert H Lurie Children’s Hospital, Evanston, IL USA
| | - Leif D. Nelin
- grid.261331.40000 0001 2285 7943The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
| | - Carl H. Coghill
- grid.265892.20000000106344187University of Alabama, Birmingham and Children’s of Alabama, Birmingham, AL USA
| | | | - Rashmin C. Savani
- University of Texas, Southwestern and Children’s Medical Center of Dallas, Dallas, TX USA
| | - William Truog
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City and Children’s Mercy Hospital, Kansas, MO USA
| | - William A. Engle
- grid.257410.50000 0004 0413 3089Indiana University and Riley Children’s Hospital, Bloomington, IN USA
| | - Joanne M. Lagatta
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, WI USA
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Avila-Alvarez A, García-Muñoz Rodrigo F, Solís-García G, Pertega-Diaz S, Sánchez Luna M, Iriondo-Sanz M, Elorza Fernandez D, Zozaya C. Nasal Intermittent Positive Pressure Ventilation and Bronchopulmonary Dysplasia Among Very Preterm Infants Never Intubated During the First Neonatal Admission: A Multicenter Cohort Study. Front Pediatr 2022; 10:896331. [PMID: 35573942 PMCID: PMC9091508 DOI: 10.3389/fped.2022.896331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION While non-invasive positive-pressure ventilation (NIPPV) is increasingly used as a mode of respiratory support for preterm infants, it remains unclear whether this technique translates into improved respiratory outcomes. We assessed the association between NIPPV use and bronchopulmonary dysplasia (BPD)-free survival in never intubated very preterm infants. METHODS This multicenter cohort study analyzed data from the Spanish Neonatal Network SEN1500 corresponding to preterm infants born at <32 weeks gestational age and <1,500 g and not intubated during first admission. The exposure of interest was use of NIPPV at any time and the main study outcome was survival without moderate-to-severe BPD. Analyses were performed both by patients and by units. Primary and secondary outcomes were compared using multilevel logistic-regression models. The standardized observed-to-expected (O/E) ratio was calculated to classify units by NIPPV utilization and outcome rates were compared among groups. RESULTS Of the 6,735 infants included, 1,776 (26.4%) received NIPPV during admission and 6,441 (95.6%) survived without moderate-to-severe BPD. After adjusting for confounding variables, NIPPV was not associated with survival without moderate-to-severe BPD (OR 0.84; 95%CI 0.62-1.14). A higher incidence of moderate-to-severe BPD-free survival was observed in high- vs. very low-utilization units, but no consistent association was observed between O/E ratio and either primary or secondary outcomes. CONCLUSION NIPPV use did not appear to decisively influence the incidence of survival without moderate-to-severe BPD in patients managed exclusively with non-invasive ventilation.
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Affiliation(s)
- Alejandro Avila-Alvarez
- Neonatal Unit, Department of Pediatrics, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.,A Coruña Biomedical Research Institute (INIBIC), A Coruña, Spain
| | - Fermín García-Muñoz Rodrigo
- Division of Neonatology, Complejo Hospitalario Universitario Insular - Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Gonzalo Solís-García
- Division of Neonatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Sonia Pertega-Diaz
- A Coruña Biomedical Research Institute (INIBIC), A Coruña, Spain.,Research Support Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Manuel Sánchez Luna
- Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Martin Iriondo-Sanz
- Division of Neonatology, Hospital Sant Joan de Déu, BCNatal, Barcelona University, Barcelona, Spain
| | | | - Carlos Zozaya
- Division of Neonatology, Hospital Universitario La Paz, Madrid, Spain
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Dani C. Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula Today. Clin Perinatol 2021; 48:711-724. [PMID: 34774205 DOI: 10.1016/j.clp.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study reviews the mechanisms of action and physiologic effects of nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC) in preterm infants with respiratory distress syndrome, discusses the main characteristics of available devices and patients' interfaces, reports on risk of failure and possible adverse effects, and summarizes clinical evidence regarding effectiveness for preventing mechanical ventilation as primary respiratory support or after extubation in the neonatal intensive care unit. nCPAP is preferred to HFNC as primary mode of noninvasive respiratory support in preterm infants with respiratory distress syndrome, whereas HFNC is an effective alternative to nCPAP after extubation.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
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38
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Abstract
Avoiding MV is a critical goal in neonatal respiratory care. Different modes of noninvasive respiratory support beyond nasal CPAP, such as nasal intermittent positive pressure ventilation (NIPPV) and synchronized NIPPV (SNIPPV), may further reduce intubation rates. SNIPPV offers consistent benefits over nonsynchronized techniques such as a more efficient positive pressure transmission to the lung, an effective increase in transpulmonary pressure during ventilation, and a better stabilization of the chest wall during inspiration. This review discusses mechanisms of action, benefits and limitations of synchronized noninvasive ventilation, describes the different modes of synchronization, and analyzes properties and clinical results.
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Affiliation(s)
- Corrado Moretti
- Department of Paediatrics, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, Rome 00185, Italy
| | - Camilla Gizzi
- Paediatric and Neonatology Unit, "Sandro Pertini" Hospital, Via Monti Tiburtini 385, Rome 00157, Italy.
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Rüegger CM, Owen LS, Davis PG. Nasal Intermittent Positive Pressure Ventilation for Neonatal Respiratory Distress Syndrome. Clin Perinatol 2021; 48:725-744. [PMID: 34774206 DOI: 10.1016/j.clp.2021.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nasal or noninvaisve intermittent positive pressure ventilation (NIPPV) refers to well-established noninvasive respiratory support strategies combining a continuous distending pressure with intermittent pressure increases. Uncertainty remains regarding the benefits provided by the various devices and techniques used to generate NIPPV. Our included meta-analyses of trials comparing NIPPV with continuous positive airway pressure (CPAP) in preterm infants demonstrate that both primary and postextubation NIPPV are superior to CPAP to prevent respiratory failure leading to additional ventilatory support. This short-term benefit is associated with a reduction in bronchopulmonary dysplasia, but not with mortality. Benefits are greatest when ventilator-generated, synchronized NIPPV is used.
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Affiliation(s)
- Christoph M Rüegger
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland.
| | - Louise S Owen
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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40
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Raidal SL, Catanchin CSM, Burgmeestre L, Quinn CT. Bi-Level Positive Airway Pressure for Non-invasive Respiratory Support of Foals. Front Vet Sci 2021; 8:741720. [PMID: 34660771 PMCID: PMC8511517 DOI: 10.3389/fvets.2021.741720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Respiratory insufficiency and pulmonary health are important considerations in equine neonatal care. As the majority of foals are bred for athletic pursuits, strategies for respiratory support of compromised foals are of particular importance. The administration of supplementary oxygen is readily implemented in equine practice settings, but does not address respiratory insufficiency due to inadequate ventilation and is no longer considered optimal care for hypoxia in critical care settings. Non-invasive ventilatory strategies including continuous or bi-level positive airway pressure are effective in human and veterinary studies, and may offer improved respiratory support in equine clinical practice. The current study was conducted to investigate the use of a commercial bi-level positive airway pressure (BiPAP) ventilator, designed for home care of people with obstructive respiratory conditions, for respiratory support of healthy foals with pharmacologically induced respiratory insufficiency. A two sequence (administration of supplementary oxygen with, or without, BiPAP), two phase, cross-over experimental design was used in a prospective study with six foals. Gas exchange and mechanics of breathing (increased tidal volume, decreased respiratory rate and increased peak inspiratory flow) were improved during BiPAP relative to administration of supplementary oxygen alone or prior studies using continuous positive airway pressure, but modest hypercapnia was observed. Clinical observations, pulse oximetry and monitoring of expired carbon dioxide was of limited benefit in identification of foals responding inappropriately to BiPAP, and improved methods to assess and monitor respiratory function are required in foals.
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Affiliation(s)
- Sharanne L Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | | | - Lexi Burgmeestre
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Chris T Quinn
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
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de Jesus Brito S, Tsopanoglou SP, Galvão EL, de Deus FA, de Lima VP. Can high-flow nasal cannula reduce the risk of bronchopulmonary dysplasia compared with CPAP in preterm infants? A systematic review and meta-analysis. BMC Pediatr 2021; 21:407. [PMID: 34530788 PMCID: PMC8444598 DOI: 10.1186/s12887-021-02881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects the premature lung, and to reduce its incidence has been used non-invasive ventilatory support, such as continuous positive airway (CPAP) and high-flow nasal cannula (HFNC). Thus, the objective of this review was to assess whether the use of high flow nasal cannula (HFNC) compared to continuous positive airway pressure (CPAP) decreases the risk of bronchopulmonary dysplasia (BPD) in premature newborns. METHODS The protocol was registered (Prospero: CRD42019136631) and the search was conducted in the MEDLINE, PEDro, Cochrane Library, CINAHL, Embase, and LILACS databases, and in the clinical trials registries, until July 2020. We included randomized clinical trials comparing HFNC versus CPAP use in premature infants born at less than 37 weeks of gestational age. The main outcome measures were the development of BPD, air leak syndrome, and nasal injury. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool and the GRADE system was used to summarize the evidence recommendations. Meta-analyses were performed using software R. RESULTS No difference was found between HFNC or CPAP for the risk of BPD (RR: 1.10; 95% CI: 0.90-1.34), air leak syndrome (RR: 1.06; 95% CI: 0.52-2.14), and nasal trauma (RR: 2.00; 95% CI: 0.64-6.25), with a very low level of evidence. CONCLUSION(S) The HFNC showed similar results when compared to CPAP in relation to the risk of BPD, air leak syndrome, and nasal injury. In the literature, no randomized clinical trial has been found with BPD as the primary outcome to support possible outcomes.
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Affiliation(s)
- Sabrina de Jesus Brito
- Physiotherapy Department, Postgraduate Program in Rehabilitation and functional performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Campus JK - Diamantina/MG, Rodovia MGT 367 - Km 583, n° 5.000 Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Sabrina Pinheiro Tsopanoglou
- Physiotherapy Departmentat, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
| | - Endi Lanza Galvão
- Graduate Program in Dentistry, Faculty of Biological and Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Franciele Angelo de Deus
- Physiotherapy Department, Postgraduate Program in Rehabilitation and functional performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Campus JK - Diamantina/MG, Rodovia MGT 367 - Km 583, n° 5.000 Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Vanessa Pereira de Lima
- Physiotherapy Department, Postgraduate Program in Rehabilitation and functional performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Campus JK - Diamantina/MG, Rodovia MGT 367 - Km 583, n° 5.000 Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
- Physiotherapy Departmentat, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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Arattu Thodika FM, Williams EE, Dassios T, Greenough A. Bilevel positive airway pressure for neonates - a short report. Acta Paediatr 2021; 110:2548-2549. [PMID: 33914368 DOI: 10.1111/apa.15895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Fahad M.S. Arattu Thodika
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
| | - Emma E. Williams
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
| | - Theodore Dassios
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Neonatal Intensive Care Centre King’s College Hospital London UK
| | - Anne Greenough
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- The Asthma UK Centre in Allergic Mechanisms of Asthma King's College London London UK
- NHS Foundation Trust and King’s College London National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ London UK
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Anne RP, Murki S. Noninvasive Respiratory Support in Neonates: A Review of Current Evidence and Practices. Indian J Pediatr 2021; 88:670-678. [PMID: 34075532 PMCID: PMC8169393 DOI: 10.1007/s12098-021-03755-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/26/2021] [Indexed: 11/09/2022]
Abstract
Respiratory distress is a common problem seen in neonates, both preterm and full term. Appropriate use of respiratory support can be life-saving in these neonates. While invasive ventilation is unavoidable in some situations, noninvasive ventilation may be sufficient in several neonates. In this review article, the authors have summarized the current evidence and the best practices to deliver effective noninvasive respiratory support.
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Affiliation(s)
- Rajendra Prasad Anne
- Department of Neonatology, Newborn Unit, Fernandez Hospitals, Unit 2, Hyderguda, Hyderabad, Telangana, India
| | - Srinivas Murki
- Department of Neonatology, Newborn Unit, Paramita Children's Hospital, Kothapet, L B Nagar, Hyderabad, Telangana, 500074, India.
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44
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Patel P, Houck A, Fuentes D. Examining Variations in Surfactant Administration (ENVISION): A Neonatology Insights Pilot Project. CHILDREN-BASEL 2021; 8:children8040261. [PMID: 33800603 PMCID: PMC8065748 DOI: 10.3390/children8040261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Abstract
Variability in neonatal clinical practice is well recognized. Respiratory management involves interdisciplinary care and often is protocol driven. The most recent published guidelines for management of respiratory distress syndrome and surfactant administration were published in 2014 and may not reflect current clinical practice in the United States. The goal of this project was to better understand variability in surfactant administration through conduct of health care provider (HCP) interviews. Questions focused on known practice variations included: use of premedication, decisions to treat, technique of surfactant administration and use of guidelines. Data were analyzed for trends and results were communicated with participants. A total of 54 HCPs participated from June to September 2020. In almost all settings, neonatologists or nurse practitioners intubated the infant and respiratory therapists administered surfactant. The INSURE (INtubation-SURrfactant-Extubation) technique was practiced by 83% of participants. Premedication prior to intubation was used by 76% of HCPs. An FiO2 ≥ 30% was the most common threshold for surfactant administration (48%). In conclusion, clinical practice variations exist in respiratory management and surfactant administration and do not seem to be specific to NICU level or institution type. It is unknown what effects the variability in clinical practice might have on clinical outcomes.
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Dumpa V, Bhandari V. Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia-Where Are We in 2021? CHILDREN-BASEL 2021; 8:children8020132. [PMID: 33670260 PMCID: PMC7918044 DOI: 10.3390/children8020132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022]
Abstract
Recent advances in neonatology have led to the increased survival of extremely low-birth weight infants. However, the incidence of bronchopulmonary dysplasia (BPD) has not improved proportionally, partly due to increased survival of extremely premature infants born at the late-canalicular stage of lung development. Due to minimal surfactant production at this stage, these infants are at risk for severe respiratory distress syndrome, needing prolonged ventilation. While the etiology of BPD is multifactorial with antenatal, postnatal, and genetic factors playing a role, ventilator-induced lung injury is a major, potentially modifiable, risk factor implicated in its causation. Infants with BPD are at a higher risk of developing complications including sepsis, pulmonary arterial hypertension, respiratory failure, and death. Long-term problems include increased risk of hospital readmissions, respiratory infections, and asthma-like symptoms during infancy and childhood. Survivors who have BPD are also at increased risk of poor neurodevelopmental outcomes. While the ultimate solution for avoiding BPD lies in the prevention of preterm births, strategies to decrease its incidence are the need of the hour. It is time to focus on gentler modes of ventilation and the use of less invasive surfactant administration techniques to mitigate lung injury, thereby potentially decreasing the burden of BPD. In this article, we discuss the use of non-invasive ventilation in premature infants, with an emphasis on studies showing an effect on BPD with different modes of non-invasive ventilation. Practical considerations in the use of nasal intermittent positive pressure ventilation are also discussed, considering the significant heterogeneity in clinical practices and management strategies in its use.
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Affiliation(s)
- Vikramaditya Dumpa
- Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, NY 11501, USA;
| | - Vineet Bhandari
- Division of Neonatology, Department of Pediatrics, Cooper Medical School of Rowan University, The Children’s Regional Hospital at Cooper, Camden, NJ 08103, USA
- Correspondence: ; Tel.: +856-342-6156 or +856-342-2000 (ext. 1089752); Fax: +856-342-8007
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Ho JJ, Subramaniam P, Davis PG. Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants. Cochrane Database Syst Rev 2020; 10:CD002271. [PMID: 33058208 PMCID: PMC8094155 DOI: 10.1002/14651858.cd002271.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae. OBJECTIVES To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress. SEARCH METHODS We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA All randomised or quasi-randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary. DATA COLLECTION AND ANALYSIS We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence. Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non-tertiary hospitals; high income compared with low income) MAIN RESULTS: We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial. CPAP was associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82; typical risk difference (RD) -0.19, 95% CI -0.28 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 4 to 11; I2 = 50%; 5 studies, 322 infants; very low-certainty evidence), lower use of ventilatory assistance (typical RR 0.72, 95% CI 0.54 to 0.96; typical RD -0.13, 95% CI -0.25 to -0.02; NNTB 8, 95% CI 4 to 50; I2 = 55%; very low-certainty evidence) and lower overall mortality (typical RR 0.53, 95% CI 0.34 to 0.83; typical RD -0.11, 95% CI -0.18 to -0.04; NNTB 9, 95% CI 2 to 13; I2 = 0%; 5 studies, 322 infants; moderate-certainty evidence). CPAP was associated with increased risk of pneumothorax (typical RR 2.48, 95% CI 1.16 to 5.30; typical RD 0.09, 95% CI 0.02 to 0.16; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 7 to 50; I2 = 0%; 4 studies, 274 infants; low-certainty evidence). There was no evidence of a difference in bronchopulmonary dysplasia, defined as oxygen dependency at 28 days (RR 1.04, 95% CI 0.35 to 3.13; I2 = 0%; 2 studies, 209 infants; very low-certainty evidence). The trials did not report use of surfactant, intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and neurodevelopment outcomes in childhood. AUTHORS' CONCLUSIONS In preterm infants with respiratory distress, the application of CPAP is associated with reduced respiratory failure, use of mechanical ventilation and mortality and an increased rate of pneumothorax compared to spontaneous breathing with supplemental oxygen as necessary. Three out of five of these trials were conducted in the 1970s. Therefore, the applicability of these results to current practice is unclear. Further studies in resource-poor settings should be considered and research to determine the most appropriate pressure level needs to be considered.
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Affiliation(s)
- Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Prema Subramaniam
- Paediatric Department, Mount Isa Base Hospital, Mount Isa, Australia
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
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