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Gaertner VD, Minocchieri S, Waldmann AD, Mühlbacher T, Bassler D, Rüegger CM. Prophylactic surfactant nebulisation for the early aeration of the preterm lung: a randomised clinical trial. Arch Dis Child Fetal Neonatal Ed 2022; 108:217-223. [PMID: 36424125 DOI: 10.1136/archdischild-2022-324519] [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: 06/07/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The effect of prophylactic surfactant nebulisation (SN) is unclear. We aimed to determine whether prophylactic SN improves early lung aeration. DESIGN Parallel, randomised clinical trial, conducted between March 2021 and January 2022. SETTING Delivery room (DR) of a tertiary neonatal centre in Zurich, Switzerland. PATIENTS Preterm infants between 26 0/7 and 31 6/7 weeks gestation INTERVENTIONS: Infants were randomised to receive positive distending pressure alone or positive distending pressure and additional SN (200 mg/kg; poractant alfa) using a customised vibrating membrane nebuliser. SN commenced with the first application of a face mask immediately after birth. MAIN OUTCOME MEASURES Primary outcome was the difference in end-expiratory lung impedance from birth to 30 min after birth (∆EELI30min). EELI correlates well with functional residual capacity. Secondary outcomes included physiological and clinical outcomes. RESULTS Data from 35 infants were collected, and primary outcome data were analysed from 32 infants (n=16/group). Primary outcome was not different between intervention and control group (median (IQR): 25 (7-62) vs 10 (0-26) AU/kg, p=0.21). ∆EELI was slightly higher in the intervention group at 6 and 12 hours after birth, particularly in the central areas of the lung. There were no differences in cardiorespiratory and clinical parameters. Two adverse events were noted in the intervention group. CONCLUSIONS Prophylactic SN in the DR did not significantly affect ∆EELI30min and showed only minimal effects on lung physiology. Prophylactic SN in the DR was feasible. There were no differences in clinical outcomes. TRIAL REGISTRATION NUMBER NCT04315636.
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Affiliation(s)
- Vincent D Gaertner
- Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stefan Minocchieri
- Department of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Tobias Mühlbacher
- Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christoph Martin Rüegger
- Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
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McGillick EV, Te Pas AB, Croughan MK, Crossley KJ, Wallace MJ, Lee K, Thio M, DeKoninck PLJ, Dekker J, Flemmer AW, Cramer SJE, Hooper SB, Kitchen MJ. Increased end-expiratory pressures improve lung function in near-term newborn rabbits with elevated airway liquid volume at birth. J Appl Physiol (1985) 2021; 131:997-1008. [PMID: 34351817 DOI: 10.1152/japplphysiol.00918.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Approximately 53% of near-term newborns admitted to intensive care experience respiratory distress. These newborns are commonly delivered by cesarean section and have elevated airway liquid volumes at birth, which can cause respiratory morbidity. We investigated the effect of providing respiratory support with a positive end-expiratory pressure (PEEP) of 8 cmH2O on lung function in newborn rabbit kittens with elevated airway liquid volumes at birth. Near-term rabbits (30 days; term = 32 days) with airway liquid volumes that corresponded to vaginal delivery (∼7 mL/kg, control, n = 11) or cesarean section [∼37 mL/kg; elevated liquid (EL), n = 11] were mechanically ventilated (tidal volume = 8 mL/kg). The PEEP was changed after lung aeration from 0 to 8 to 0 cmH2O (control, n = 6; EL, n = 6), and in a separate group of kittens, PEEP was changed after lung aeration from 8 to 0 to 8 cmH2O (control, n = 5; EL, n = 5). Lung function (ventilator parameters, compliance, lung gas volumes, and distribution of gas within the lung) was evaluated using plethysmography and synchrotron-based phase-contrast X-ray imaging. EL kittens initially receiving 0 cmH2O PEEP had reduced functional residual capacities and lung compliance, requiring higher inflation pressures to aerate the lung compared with control kittens. Commencing ventilation with 8 cmH2O PEEP mitigated the adverse effects of EL, increasing lung compliance, functional residual capacity, and the uniformity and distribution of lung aeration, but did not normalize aeration of the distal airways. Respiratory support with PEEP supports lung function in near-term newborn rabbits with elevated airway liquid volumes at birth who are at a greater risk of suffering respiratory distress.NEW & NOTEWORTHY Term babies born by cesarean section have elevated airway liquid volumes, which predisposes them to respiratory distress. Treatments targeting molecular mechanisms to clear lung liquid are ineffective for term newborn respiratory distress. We showed that respiratory support with an end-expiratory pressure supports lung function in near-term rabbits with elevated airway liquid volumes at birth. This study provides further physiological understanding of lung function in newborns with elevated airway liquid volumes at risk of respiratory distress.
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Affiliation(s)
- Erin V McGillick
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Michelle K Croughan
- School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia
| | - Kelly J Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Megan J Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Katie Lee
- School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia
| | - Marta Thio
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.,The Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philip L J DeKoninck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Janneke Dekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Andreas W Flemmer
- Division of Neonatology, University Children's Hospital and Perinatal Centre, Ludwig-Maximilians University, Munich, Germany
| | - Sophie J E Cramer
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Marcus J Kitchen
- School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia
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Veneroni C, Tingay DG, McCall KE, Pereira-Fantini PM, Perkins EJ, Dargaville PA, Dellacà RL. Respiratory mechanics during initial lung aeration at birth in the preterm lamb. Am J Physiol Lung Cell Mol Physiol 2020; 318:L525-L532. [PMID: 31913650 DOI: 10.1152/ajplung.00302.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite recent insights into the dynamic processes during lung aeration at birth, several aspects remain poorly understood. We aimed to characterize changes in lung mechanics during the first inflation at birth and their relationship to changes in lung volume. Intubated preterm lambs (gestational age, 124-127 days; n = 17) were studied at birth. Lung volume changes were measured by electrical impedance tomography (VLEIT). Respiratory system resistance (R5) and oscillatory compliance (Cx5) were monitored with the forced oscillation technique at 5 Hz. Lambs received 3-7 s of 8 cmH2O of continuous distending pressure (CDP) before delivery of a sustained inflation (SI) of 40 cmH2O. The SI was then applied until either Cx5 or the VLEIT or the airway opening volume was stable. CDP was resumed for 3-7 s before commencement of mechanical ventilation. The exponential increases with time of Cx5 and VLEIT from commencement of the SI were characterized by estimating their time constants (τCx5 and τVLEIT, respectively). During SI, a fast decrease in R5 and an exponential increase in Cx5 and VLEIT were observed. Cx5 and VLEIT provided comparable information on the dynamics of lung aeration in all lambs, with τCx5 and τVLEIT being highly linearly correlated (r2 = 0.87, P < 0.001). Cx5 and VLEIT decreased immediately after SI. Despite the standardization of the animal model, changes in Cx5 and R5 both during and after SI were highly variable. Lung aeration at birth is characterized by a fast reduction in resistance and a slower increase in oscillatory compliance, the latter being a direct reflection of the amount of lung aeration.
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Affiliation(s)
- Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Karen E McCall
- Department of Neonatology, Wishaw General Hospital, Wishaw, United Kingdom.,School of Medicine and Medical Sciences, University College Dublin, Ireland
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Peter A Dargaville
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
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McGillick EV, Lee K, Yamaoka S, te Pas AB, Crossley KJ, Wallace MJ, Kitchen MJ, Lewis RA, Kerr LT, DeKoninck P, Dekker J, Thio M, McDougall AR, Hooper SB. Elevated airway liquid volumes at birth: a potential cause of transient tachypnea of the newborn. J Appl Physiol (1985) 2017; 123:1204-1213. [DOI: 10.1152/japplphysiol.00464.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022] Open
Abstract
Excessive liquid in airways and/or distal lung tissue may underpin the respiratory morbidity associated with transient tachypnea of the newborn (TTN). However, its effects on lung aeration and respiratory function following birth are unknown. We investigated the effect of elevated airway liquid volumes on newborn respiratory function. Near-term rabbit kittens (30 days gestation; term ~32 days) were delivered, had their lung liquid-drained, and either had no liquid replaced (control; n = 7) or 30 ml/kg of liquid re-added to the airways [liquid added (LA); n = 7]. Kittens were mechanically ventilated in a plethysmograph. Measures of chest and lung parameters, uniformity of lung aeration, and airway size were analyzed using phase contrast X-ray imaging. The maximum peak inflation pressure required to recruit a tidal volume of 8 ml/kg was significantly greater in LA compared with control kittens (35.0 ± 0.7 vs. 26.8 ± 0.4 cmH2O, P < 0.001). LA kittens required greater time to achieve lung aeration (106 ± 14 vs. 60 ± 6 inflations, P = 0.03) and had expanded chest walls, as evidenced by an increased total chest area (32 ± 9%, P < 0.0001), lung height (17 ± 6%, P = 0.02), and curvature of the diaphragm (19 ± 8%, P = 0.04). LA kittens had lower functional residual capacity during stepwise changes in positive end-expiratory pressures (5, 3, 0, and 5 cmH20). Elevated lung liquid volumes had marked adverse effects on lung structure and function in the immediate neonatal period and reduced the ability of the lung to aerate efficiently. We speculate that elevated airway liquid volumes may underlie the initial morbidity in near-term babies with TTN after birth. NEW & NOTEWORTHY Transient tachypnea of the newborn reduces respiratory function in newborns and is thought to result due to elevated airway liquid volumes following birth. However, the effect of elevated airway liquid volumes on neonatal respiratory function is unknown. Using phase contrast X-ray imaging, we show that elevated airway liquid volumes have adverse effects on lung structure and function in the immediate newborn period, which may underlie the pathology of TTN in near-term babies after birth.
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Affiliation(s)
- Erin V. McGillick
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
| | - Katie Lee
- School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia
| | - Shigeo Yamaoka
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
| | - Arjan B. te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kelly J. Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
| | - Megan J. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
| | - Marcus J. Kitchen
- School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia
| | - Robert A. Lewis
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lauren T. Kerr
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
| | - Philip DeKoninck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
| | - Janneke Dekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta Thio
- Women’s Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia; and
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Annie R.A. McDougall
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
| | - Stuart B. Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology Monash University, Melbourne, Victoria, Australia
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