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Trinh SH, Tövisházi G, Kátai LK, Bogner LL, Maka E, Balog V, Szabó M, Szabó AJ, Gál J, Jermendy Á, Hauser B. Airway management may influence postoperative ventilation need in preterm infants after laser eye treatment. Pediatr Res 2024:10.1038/s41390-024-03356-4. [PMID: 38909156 DOI: 10.1038/s41390-024-03356-4] [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: 12/20/2023] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Retinopathy of prematurity is treated with laser photocoagulation under general anaesthesia with intubation using endotracheal tube (ETT), which carries a risk for postoperative mechanical ventilation (MV). Laryngeal mask airway (LMA) may provide a safe alternative. We assessed the need for postoperative MV in preterm infants who received LMA versus ETT. METHODS In this single-centre, retrospective cohort study, preterm infants who underwent laser photocoagulation between 2014-2021 were enroled. For airway management, patients received either LMA (n = 224) or ETT (n = 47). The outcome was the rate of postoperative MV. RESULTS Patients' age were 37 [35;39] weeks of postmenstrual age, median bodyweight of Group LMA was higher than Group ETT's (2110 [1800;2780] g versus 1350 [1230;1610] g, respectively, p < 0.0001). After laser photocoagulation, 8% of Group LMA and 74% of Group ETT left the operating theatre requiring MV. Multiple logistic regression revealed that the use of LMA and every 100 g increase in bodyweight significantly decreased the odds of mechanical ventilation (OR 0.21 [95% CI 0.07-0.60], and 0.73 [95% CI 0.63-0.84], respectively). Propensity score matching confirmed that LMA decreased the odds of postoperative MV (OR 0.30 [95% CI 0.11-0.70]). CONCLUSION The use of LMA is associated with a reduced need for postoperative MV. IMPACT Using laryngeal mask airway instead of endotracheal tube for airway management in preterm infants undergoing general anaesthesia for laser photocoagulation for treating retinopathy of prematurity could significantly decrease the postoperative need for mechanical ventilation. According to our current understanding, this has been the largest study investigating the effect of laryngeal mask airway during general anaesthesia in preterm infants. Our study suggests that the use of laryngeal mask airway is a viable alternative to intubation in the vulnerable population of preterm infants in need of laser treatment.
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Affiliation(s)
- Sarolta H Trinh
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Gyula Tövisházi
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- Institute of Anaesthesiology and Perioperative Care, Semmelweis University, Budapest, Hungary
| | - Lóránt K Kátai
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Luca L Bogner
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Erika Maka
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Vera Balog
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Miklós Szabó
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Attila J Szabó
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Ágnes Jermendy
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Balázs Hauser
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
- Institute of Anaesthesiology and Perioperative Care, Semmelweis University, Budapest, Hungary.
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Dassios T, Harris C, Williams EE, Greenough A. Sex differences in preterm respiratory morbidity: A recent whole-population study. Acta Paediatr 2024; 113:745-750. [PMID: 38126241 DOI: 10.1111/apa.17071] [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: 11/07/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
AIM To determine whether there were differences between male and female infants in respiratory morbidity in a whole population of extremely preterm infants, including infants born below 24 weeks of gestation. METHODS Retrospective whole-population study of all infants <28 weeks of gestation admitted to a neonatal unit in England from 2014 to 2019. Bronchopulmonary dysplasia (BPD) development was defined as any respiratory support at 36 weeks postmenstrual age. RESULTS The 11 844 infants had a median (IQR) gestational age of 26.0 (24.9-27.1) weeks and a birth weight of 0.81 (0.67-0.96) kg. The duration of invasive ventilation was longer in male compared to female infants who were born at 24-27 completed weeks of gestation (p < 0.001), but not significantly different between male and female infants born at 22 and 23 weeks of gestation (p = 0.446). The incidence of BPD was higher in male compared to female infants born at 24-27 weeks of gestation (p < 0.001) but not different between male and female infants born at 22 and 23 weeks of gestation (p = 0.148). CONCLUSION Respiratory morbidity was more pronounced in male compared to female extremely preterms, only in gestations 24-27 completed weeks. Male predominance was absent in infants born below 24 weeks of gestation.
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Affiliation(s)
- Theodore Dassios
- Faculty of Life Science and Medicine, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Patras, Patras, Greece
| | - Christopher Harris
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Emma E Williams
- Faculty of Life Science and Medicine, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Anne Greenough
- Faculty of Life Science and Medicine, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Kuitunen I, Räsänen K. Less Invasive Surfactant Administration Compared to Intubation, Surfactant, Rapid Extubation Method in Preterm Neonates: An Umbrella Review. Neonatology 2024:1-9. [PMID: 38503270 DOI: 10.1159/000537903] [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: 10/21/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION In spontaneously breathing neonates, surfactant can be administered via thin catheter while enabling the own breathing (less invasive surfactant administration [LISA]). Alternatively, the neonate is intubated for surfactant delivery (intubation, surfactant, rapid extubation [INSURE]). Thus, the aim was to provide an overview of the efficacy of the LISA compared to INSURE. METHODS We performed an umbrella review of previous meta-analyses including randomized controlled trials. We searched PubMed, Scopus, and Web of Science in July 2023. Two authors screened the search results, and systematic reviews with meta-analyses that focused on LISA versus INSURE were included. One author extracted, and another author validated the extracted data. AMSTAR-2 and ROBIS evaluations were performed by two authors independently. RESULTS A total of 9 systematic reviews with meta-analyses were included. The quality according to AMSTAR-2 was high in one, moderate in one, low in three, and critically low in four. According to ROBIS, the risk of bias was low in three and high in six of the reviews. LISA was more effective than INSURE in preventing mechanical ventilation (8/8 reviews), death or BPD (4/4 reviews), death (3/9 reviews), and BPD (3/9 reviews). CONCLUSIONS All the included systematic reviews and meta-analyses reported LISA to be more effective than INSURE in terms of need for mechanical ventilation and death or BPD. However, the quality of the published systematic reviews has been mostly deficient. Future systematic reviews should focus on reporting quality.
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Affiliation(s)
- Ilari Kuitunen
- Department of Pediatrics and Neonatology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kati Räsänen
- Department of Pediatrics and Neonatology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Zafar A, Hall M. Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review. Pediatr Pulmonol 2024. [PMID: 38197530 DOI: 10.1002/ppul.26848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/11/2024]
Abstract
Bronchopulmonary dysplasia also known as chronic lung disease of prematurity has changed as a disease entity over the last five decades and children with "new bronchopulmonary dysplasia (BPD)" have better survival rates. This necessitates strategies to prevent severe BPD and provide organized home support. Home respiratory support in these children varies from home oxygen to noninvasive ventilation and tracheostomy ventilation. This review was conducted utilizing Joanna Briggs Institute publications on evidence synthesis and presentation of results for a scoping review. The Preferred Reporting Items for Systematic Review and Meta-Analyses were used to report the results. The risk of bias assessment was done using "The Cochrane Handbook for Systematic Reviews tool for interventional studies." After screening for the duplication of results and applying inclusion and exclusion criteria, twenty-seven studies were assessed by reading the full texts. Out of these, eleven were finally included in this systematic review. The total sample size from all studies was 4794, including 2705 males. The 4/11 studies home oxygen, one study reported continuous positive airway pressure/bilevel positive airway pressure and seven studies used tracheostomy or tracheostomy ventilation. The median duration of post-natal invasive ventilation was higher in those discharged on home oxygen compared to those who did not need oxygen at discharge. There is a significant proportion of children who are tracheostomy ventilated (8.65%) at home. In the absence of established guidelines, these children are vulnerable when it comes to care at home and the timing of decannulation. For home oxygen alone, guidelines by ERS, ATS and BTS have streamlined weaning protocols and the need for having a multi-disciplinary team to care for these children.
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Affiliation(s)
- Adnan Zafar
- Pediatric Pulmonology, John Hopkins Aramco Healthcare, Saudi Arabia
| | - Michael Hall
- Neonatology, University of Southampton, Southampton, UK
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Yang Y, Gu XY, Lin ZL, Pan SL, Sun JH, Cao Y, Lee SK, Wang JH, Cheng R. Effect of different courses and durations of invasive mechanical ventilation on respiratory outcomes in very low birth weight infants. Sci Rep 2023; 13:18991. [PMID: 37923908 PMCID: PMC10624920 DOI: 10.1038/s41598-023-46456-7] [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: 08/12/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023] Open
Abstract
This multicenter retrospective study was conducted to explore the effects of different courses and durations of invasive mechanical ventilation (MV) on the respiratory outcomes of very low birth weight infants (VLBWI) in China. The population for this study consisted of infants with birth weight less than 1500 g needing at least 1 course of invasive MV and admitted to the neonatal intensive care units affiliated with the Chinese Neonatal Network within 6 h of life from January 1st, 2019 to December 31st, 2020. Univariate and multivariate logistic regression analyses were performed to evaluate associations between invasive MV and respiratory outcomes. Adjusted odds ratios (ORs) were computed with the effects of potential confounders. (1) Among the 3183 VLBWs with a history of at least one course of invasive MV, 3155 (99.1%) met inclusion criteria and were assessed for the primary outcome. Most infants received one course (76.8%) and a shorter duration of invasive MV (62.16% with ventilation for 7 days or less). (2) In terms of the incidence of all bronchopulmonary dysplasia (BPD) (mild, moderate, and severe BPD), there were no significant differences between different invasive MV courses [For 2 courses, adjusted OR = 1.11 (0.88, 1.39); For 3 courses or more, adjusted OR = 1.07 (0.72, 1.60)]. But, with the duration of invasive MV prolonging, the OR of BPD increased [8-21 days, adjusted OR = 1.98 (1.59, 2.45); 22-35 days, adjusted OR = 4.37 (3.17, 6.03); ≥ 36 days, adjusted OR = 18.44 (10.98, 30.99)]. Concerning severe BPD, the OR increased not only with the course of invasive MV but also with the duration of invasive MV [For 2 courses, adjusted OR = 2.17 (1.07, 4.40); For 3 courses or more, adjusted OR = 2.59 (1.02, 6.61). 8-21 days, adjusted OR = 8.42 (3.22, 22.01); 22-35 days, adjusted OR = 27.82 (9.08, 85.22); ≥ 36 days, adjusted OR = 616.45 (195.79, > 999.999)]. (3) When the interaction effect between invasive MV duration and invasive MV course was considered, it was found that there were no interactive effects in BPD and severe BPD. Greater than or equal to three courses would increase the chance of severe BPD, death, and the requirement of home oxygen therapy. Compared with distinct courses of invasive MV, a longer duration of invasive MV (> 7 days) has a greater effect on the risk of BPD, severe BPD, death, and the requirement of home oxygen therapy.
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Affiliation(s)
- Yang Yang
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xin-Yue Gu
- NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Zhen-Lang Lin
- Department of Neonatology, Wenzhou Medical College Affiliated Yuying Children's Hospital, Wenzhou, China
| | - Shu-Lin Pan
- Department of Neonatology, Wenzhou Medical College Affiliated Yuying Children's Hospital, Wenzhou, China
| | - Jian-Hua Sun
- Department of Neonatology, Shanghai Children's Medical Center Affiliated with the School of Medicine of Shanghai Jiaotong University, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Department of Pediatrics, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jian-Hui Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China.
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Dassios T, Williams EE, Kaltsogianni O, Greenough A. Permissive hypercapnia and oxygenation impairment in premature ventilated infants. Respir Physiol Neurobiol 2023; 317:104144. [PMID: 37647975 DOI: 10.1016/j.resp.2023.104144] [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] [Received: 06/06/2023] [Revised: 08/04/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023]
Abstract
AIM In permissive hypercapnia high levels of carbon dioxide (CO2) are tolerated in ventilated preterm infants to minimise lung injury, but hypercapnia could directly impair oxygenation. We aimed to quantify the association of elevated CO2 with oxygenation impairment in preterm infants by measuring the right-to-left shunt and the ventilation/perfusion (VA/Q) ratio. METHODS Pre-existing datasets from preterm infants during the acute phase of respiratory distress syndrome or with evolving or established bronchopulmonary dysplasia were analysed. Non-invasive paired measurements of the fraction of inspired oxygen (FIO2) and transcutaneous oxygen saturation (SpO2) were used to calculate the degree of right-to-left shunt, right shift of the FIO2 versus SpO2 curve and the VA/Q. RESULTS A total of 75 infants (43 male) with a median (IQR) gestational age of 26.4 (24.7-27.7) weeks were studied at 7 (2-31) days. Thirty-six infants (48 %) had an arterial partial pressure of CO2 (PaCO2) above 6 kPa. The PaCO2 was independently associated with the right shift of the curve [adjusted p < 0.001, unstandardised coefficient; 2.26, 95 % CI: 1.51-2.95] and the right-to-left shunt [adjusted p = 0.016, unstandardised coefficient; 1.86, 95 % CI: 0.36-3.36] after adjusting for confounders. An increase of the PaCO2 from 5 to 8 kPa, corresponded to a right shift of the curve of 20.2 kPa or a decrease in the VA/Q from 0.66 to 0.24. CONCLUSIONS Increased carbon dioxide levels were significantly associated with impaired oxygenation in preterm infants with respiratory distress syndrome or bronchopulmonary dysplasia.
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Affiliation(s)
- Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; Neonatal Intensive Care Unit, University of Patras, Patras, Greece.
| | - Emma E Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Ourania Kaltsogianni
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
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Jo HS, Lim MN, Cho SI. Required biological time for lung maturation and duration of invasive ventilation: a Korean cohort study of very low birth weight infants. Front Pediatr 2023; 11:1184832. [PMID: 37416815 PMCID: PMC10320392 DOI: 10.3389/fped.2023.1184832] [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: 03/12/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Abstract
Background We investigated the duration of invasive ventilation among very low birth weight (VLBW) infants to evaluate the current minimum time required for lung maturation to breathe without ventilator assistance after preterm birth. Methods A total of 14,658 VLBW infants born at ≤32+6 weeks between 2013 and 2020 were enrolled. Clinical data were collected from the Korean Neonatal Network, a national prospective cohort registry of VLBW infants from 70 neonatal intensive care units. Differences in the duration of invasive ventilation according to gestational age and birth weight were investigated. Recent trends and changes in assisted ventilation duration and associated perinatal factors between 2017-20 and 2013-16 were compared. Risk factors related to the duration of assisted ventilation were also identified. Results The overall duration of invasive ventilation was 16.3 days and the estimated minimum time required corresponded to 30+4 weeks of gestation. The median duration of invasive ventilation was 28.0, 13.0, 3.0, and 1.0 days at <26, 26-27, 28-29, and 30-32 weeks of gestation, respectively. In each gestational age group, the estimated minimum weaning points from the assisted ventilator were 29+5, 30+2, 30+2, and 31+5 weeks of gestation. The duration of non-invasive ventilation (17.9 vs. 22.5 days) and the incidence of bronchopulmonary dysplasia (28.1% vs. 31.9%) increased in 2017-20 (n = 7,221) than in 2013-16 (n = 7,437). In contrast, the duration of invasive ventilation and overall survival rate did not change during the periods 2017-20 and 2013-16. Surfactant treatment and air leaks were associated with increased duration of invasive ventilation (inverse hazard ratio 1.50, 95% CI, 1.04-2.15; inverse hazard ratio 1.62, 95% CI, 1.29-2.04). We expressed the incidence proportion of ventilator weaning according to the invasive ventilation duration using Kaplan-Meier survival curves. The slope of the curve slowly decreased as gestational age and birth weight were low and risk factors were present. Conclusions This population-based data on invasive ventilation duration among VLBW infants suggest the present limitation of postnatal lung maturation under specific perinatal conditions after preterm birth. Furthermore, this study provides detailed references for designing and/or assessing earlier ventilator weaning protocols and lung protection strategies by comparing populations or neonatal networks.
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Affiliation(s)
- Heui Seung Jo
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Myoung Nam Lim
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Sung-Il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Dou C, Yu YH, Zhuo QC, Qi JH, Huang L, Ding YJ, Yang DJ, Li L, Li D, Wang XK, Wang Y, Qiao X, Zhang X, Zhang BJ, Jiang HY, Li ZL, Reddy S. Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a multicentrer prospective study. World J Pediatr 2023; 19:577-585. [PMID: 36604390 PMCID: PMC10198849 DOI: 10.1007/s12519-022-00671-w] [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: 08/16/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to evaluate the risk factors for moderate-to-severe bronchopulmonary dysplasia (BPD) and focus on discussing its relationship with the duration of initial invasive mechanical ventilation (IMV) in very preterm neonates less than 32 weeks of gestational age (GA). METHODS We performed a prospective cohort study involving infants born at 23-31 weeks of GA who were admitted to 47 different neonatal intensive care unit (NICU) hospitals in China from January 2018 to December 2021. Patient data were obtained from the Sina-northern Neonatal Network (SNN) Database. RESULTS We identified 6538 very preterm infants, of whom 49.5% (3236/6538) received initial IMV support, and 12.6% (823/6538) were diagnosed with moderate-to-severe BPD symptoms. The median duration of initial IMV in the moderate-to-severe BPD group was 26 (17-41) days, while in the no or mild BPD group, it was 6 (3-10) days. The incidence rate of moderate-to-severe BPD and the median duration of initial IMV were quite different across different GAs. Multivariable logistic regression analysis showed that the onset of moderate-to-severe BPD was significantly associated with the duration of initial IMV [adjusted odds ratio (AOR): 1.97; 95% confidence interval (CI): 1.10-2.67], late-onset neonatal sepsis (LONS), and patent ductus arteriosus (PDA). CONCLUSION In this multicenter cohort study, the duration of initial IMV was still relatively long in very premature infants, and the longer duration of initial IMV accounts for the increased risk of moderate-to-severe BPD.
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Affiliation(s)
- Cong Dou
- Department of Neonatology, Maternal and Child Health Care Hospital of Shandong Province, Shandong University, Jinan, 250014, China
| | - Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China.
- Department of Neonatology, Shandong Provincial Hospital, Shandong University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China.
| | - Qing-Cui Zhuo
- Department of Neonatology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Jian-Hong Qi
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China
| | - Lei Huang
- Department of Neonatology, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, 250014, China
| | - Yan-Jie Ding
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - De-Juan Yang
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, China
| | - Li Li
- Department of Neonatology, Linyi People's Hospital, Linyi, 276000, China
| | - Dan Li
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Xiao-Kang Wang
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China
| | - Yan Wang
- Department of Neonatology, The Affiliated Taian City Central Hospital of Qingdao University, Taian, 271000, China
| | - Xin Qiao
- Department of Neonatology, Jinan Maternity and Child Healthcare Hospital, Jinan, 250001, China
| | - Xiang Zhang
- Department of Neonatology, Hebei Petro China Central Hospital, Langfang, 065000, China
| | - Bing-Jin Zhang
- Department of Neonatology, Shengli Olifield Central Hospital, Dongying, 257000, China
| | - Hai-Yan Jiang
- Department of Neonatology, The Third Hospital of Baogang Group, Baotou, 014000, China
| | - Zhong-Liang Li
- Department of Neonatology, W.F. Maternal and Child Health Hospital, Weifang, 261011, China
| | - Simmy Reddy
- Cheeloo College of Medicine, Shandong University, Jinan, 250000, China
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Menshykova AO, Dobryanskyy DO. Duration of mechanical ventilation and clinical outcomes in very low birth weight infants: A single center 10-years cohort study. J Neonatal Perinatal Med 2023; 16:673-680. [PMID: 38043024 DOI: 10.3233/npm-230142] [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: 12/04/2023]
Abstract
BACKGROUND Despite the important role of MV in reducing mortality in very preterm infants, its use is often associated with complications. The study was aimed to determine the duration of mechanical ventilation (MV), which significantly increased the risk of adverse outcomes in very low birth weight (VLBW) infants. METHODS Data obtained from a prospectively created computer database were used in a retrospective cohort study. The database included information about 1980 VLBW infants <32 weeks of gestation who were cared for at the tertiary care center between January 2010 and December 2020. RESULTS Out of 1980 VLBW infants, 1086 (55%) were ventilated sometime during the hospital stay. 678 (62.43%) of ventilated babies survived until discharge. With ROC analysis, it was identified that MV duration of 60.5 hours had 79.3% sensitivity and 64.6% specificity for the prediction of BPD with the AUC of 0.784 (95% CI 0.733-0.827; p < 0.0001). The duration of MV above 60.5 hours was a significant risk factor for bronchopulmonary dysplasia (aOR 6.005, 95% CI 3.626-9.946), death (aOR 3.610, 95% CI 2.470-5.276), bronchopulmonary dysplasia/death (aOR 4.561, 95% CI 3.328-6.252), sepsis (aOR 1.634, 95% CI 1.168-2.286), necrotizing enterocolitis (aOR 2.606, 95% CI 1.364-4.980), and periventricular leukomalacia (aOR 2.191, 95% CI 1.241-3.867). CONCLUSIONS Duration of MV longer than 60.5 hours is an independent risk factor for adverse outcomes in VLBW infants. It is essential to increase and optimize efforts to avoid MV or extubate very preterm infants as soon as possible, before reaching the established threshold duration of invasive respiratory support.
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Affiliation(s)
- A O Menshykova
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - D O Dobryanskyy
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Alonso-Ojembarrena A, Méndez-Abad P, Alonso-Quintela P, Zafra-Rodríguez P, Oulego-Erroz I, Lubián-López SP. Lung ultrasound score has better diagnostic ability than NT-proBNP to predict moderate-severe bronchopulmonary dysplasia. Eur J Pediatr 2022; 181:3013-3021. [PMID: 35648231 DOI: 10.1007/s00431-022-04491-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED The N-terminal end of B-type natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) score have been proven to be adequate early biomarkers of bronchopulmonary dysplasia (BPD) in preterm infants. Our aim was to study if the predictive capacity of each one is increased by analyzing them together. We included infants born before 32 weeks with NT-proBNP and LUS scores on the first day of life (DOL) and on the 3rd, 7th, and 14th DOL and compared the diagnostic ability for moderate-severe BPD (msBPD) of each biomarker and in combination. We also compared them with a multivariate model of msBPD using only clinical variables. The sample size was 133 patients, and twenty-seven (20%) developed msBPD. The LUS score on the 7th DOL had better performance than NT-proBNP at the same moment: area under the receiver operating characteristic curve (AUC) 0.83 (0.75-0.89) versus 0.66 (0.56-0.75), p = 0.003, without differences in the rest of the times studied. These values did not increase when using the combination of both. A multivariate regression model that included only clinical variables (birth weight and invasive mechanical ventilation (IMV) at the 7th DOL) predicted msBPD with the same AUC as after the addition of any of these biomarkers, neither together. CONCLUSION The LUS score is a better predictor of msBPD on the 7th DOL than NT-proBNP in preterm infants born before 32 weeks, although they have similar diagnostic accuracy on the 1st, 3rd, and 14th DOL. Neither of them, nor together, have a better AUC for msBPD than a clinical model with birthweight and the need for IMV at the 7th DOL. WHAT IS KNOWN • NT-proBNP and LUS score are early predictors of moderate-severe bronchopulmonary dysplasia (msBPD). WHAT IS NEW • The combination of both NT-proBNP and LUS score does not increase the predictive ability of each separately.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain. .,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
| | - Paula Méndez-Abad
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Paula Alonso-Quintela
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain.,Biomedicine Institute of León (IBIOMED), University of León, León, Spain
| | - Pamela Zafra-Rodríguez
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Ignacio Oulego-Erroz
- Biomedicine Institute of León (IBIOMED), University of León, León, Spain.,Pediatric Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain.,Working Group On Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care (SECIP), Madrid, Spain
| | - Simón P Lubián-López
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Maternal and Child Health and Radiology, School of Medicine, University of Cádiz, Cádiz, Spain
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Dassios T, Williams EE, Harris C, Greenough A. Using cluster analysis to describe phenotypical heterogeneity in extremely preterm infants: a retrospective whole-population study. BMJ Open 2022; 12:e056567. [PMID: 35228290 PMCID: PMC8886439 DOI: 10.1136/bmjopen-2021-056567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To use cluster analysis to identify discrete phenotypic groups of extremely preterm infants. DESIGN Secondary analysis of a retrospective whole population study. SETTING All neonatal units in England between 2014 and 2019. PARTICIPANTS Infants live-born at less than 28 weeks of gestation and admitted to a neonatal unit. INTERVENTIONS K-means cluster analysis was performed with the gestational age, Apgar score at 5 min and duration of mechanical ventilation as input variables. PRIMARY AND SECONDARY OUTCOME MEASURES Bronchopulmonary dysplasia, discharge on home oxygen, intraventricular haemorrhage, death before discharge from neonatal care. RESULTS Ten thousand one hundred and ninety-seven infants (53% male) were classified into four clusters: Cluster 1 contained infants with intermediate gestation and duration of ventilation and had an intermediate mortality and incidence of bronchopulmonary dysplasia. Cluster 2 contained infants with the highest gestation, a shorter duration of ventilation and the lowest mortality. Cluster 3 contained infants with the lowest Apgar score and highest mortality and incidence of intraventricular haemorrhage. Cluster 4 contained infants with the lowest gestation, longest duration of ventilation and highest incidence of bronchopulmonary dysplasia. CONCLUSION Clinical parameters can classify extremely preterm infants into discrete phenotypic groups with differing subsequent neonatal outcomes.
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Affiliation(s)
- Theodore Dassios
- Department of Women and Children's Health, School of Life Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Emma E Williams
- Department of Women and Children's Health, School of Life Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
- Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
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12
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Lin H, Chen X, Ge J, Shi L, Du L, Ma X. Home oxygen use and 1-year outcome among preterm infants with bronchopulmonary dysplasia discharged from a Chinese regional NICU. Front Pediatr 2022; 10:978743. [PMID: 36160774 PMCID: PMC9500185 DOI: 10.3389/fped.2022.978743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aims to compare the clinical characteristics and 1-year outcomes of preterm infants with bronchopulmonary dysplasia (BPD) who were discharged on supplemental oxygen or room air. MATERIALS AND METHODS The preterm infants (born <32 weeks' gestation, birth weight ≤1,250 g) diagnosed with BPD and admitted between January 2020 and December 2020 were enrolled. The clinical data during hospitalization were collected through the hospital's electronic record system. The outcomes after discharge were acquired from the outpatient system and through telephonic interviews. RESULTS Of the 87 preterm infants diagnosed with BPD, 81 infants survived until discharge. The 81 infants were divided into the home oxygen group (n = 29) and room air group (n = 52) according to supplemental oxygen or not at discharge. Infants in the home oxygen group were more likely to receive postnatal systemic steroids and higher ventilation settings at 36 weeks' PMA. There was one patient in each group who died before 1 year corrected age, respectively. All the infants had successfully weaned off oxygen eventually during the first year. The median duration of home oxygen therapy was 25 (7,42) days. Readmission occurred in 49 (64.5%) infants. Readmissions for infants with home oxygen were more often related to respiratory disease. In addition, wheezing disorders and home inhalation occurred more frequently in the home oxygen group (p = 0.022, p = 0.004). Although the incidence of underweight at 1 year corrected age was higher in the room air group (10.0 vs. 3.8%), there was no significant difference (p = 0.620). The rate of neurodevelopmental impairment was similar between these two groups (26.0 vs. 30.8%, p = 0.659). CONCLUSIONS It was the first study focused on preterm infants with BPD receiving home oxygen in China. Infants with home oxygen were more likely to have respiratory problems after discharge from NICU. Home oxygen use was not associated with more readmission for infants with BPD, and no difference was found in neurodevelopmental impairment and growth outcome.
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Affiliation(s)
- Huijia Lin
- Department of NICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xuefeng Chen
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jiajing Ge
- Department of NICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Liping Shi
- Department of NICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lizhong Du
- Department of NICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaolu Ma
- Department of NICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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