Non-invasive respiratory support in preterm infants as primary mode: a network meta-analysis

2021 ◽  
Vol 2021 (11) ◽  
Author(s):  
Amit Mukerji ◽  
Prakeshkumar S Shah ◽  
Xiang Y Ye ◽  
Abdul Razak
Keyword(s):  
Preterm Infants ◽  
Meta Analysis ◽  
Respiratory Support ◽  
Primary Mode ◽  
Non Invasive ◽  
Mode A

scholarly journals Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis

BMJ ◽  
2013 ◽  
Vol 347 (oct17 3) ◽  
pp. f5980-f5980 ◽  
Author(s):  
G. M. Schmolzer ◽  
M. Kumar ◽  
G. Pichler ◽  
K. Aziz ◽  
M. O'Reilly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Respiratory Support ◽  
Non Invasive

Automated control of oxygen titration in preterm infants on non-invasive respiratory support

2021 ◽  
pp. fetalneonatal-2020-321538
Author(s):  
Peter A Dargaville ◽  
Andrew P Marshall ◽  
Oliver J Ladlow ◽  
Charlotte Bannink ◽  
Rohan Jayakar ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Supplemental Oxygen ◽  
Respiratory Support ◽  
Target Range ◽  
Manual Control ◽  
Oxygen Control ◽  
Automated Control ◽  
Non Invasive ◽  
Automated Oxygen Control

ObjectiveTo evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency.DesignInterventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each).SettingNeonatal intensive care unit.ParticipantsPreterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26–28) and postnatal age 17 (12–23) days.InterventionAutomated oxygen titration with the VDL1.1 algorithm, with the incoming SpO2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO2) adjustments actuated by a motorised blender. The desired SpO2 range was 90%–94%, with bedside clinicians able to make corrective manual FiO2 adjustments at all times.Main outcome measuresTarget range (TR) time (SpO2 90%–94% or 90%–100% if in air), periods of SpO2 deviation, number of manual FiO2 adjustments and oxygen requirement were compared between automated and manual control periods.ResultsIn 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51–64)% vs automated 81 (72–85)%, p<0.001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25–32)% and automated 26 (24–32)%, p=0.13).ConclusionThe VDL1.1 algorithm was safe and effective in SpO2 targeting in preterm infants on non-invasive respiratory support.Trial registration numberACTRN12616000300471.

Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

2019 ◽  
Vol 35 (4) ◽  
pp. 298-306 ◽  
Author(s):  
Nigel Fleeman ◽  
Yenal Dundar ◽  
Prakesh S Shah ◽  
Ben NJ Shaw
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Primary Outcome ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Cochrane Library ◽  
High Flow Nasal Cannula ◽  
Safe Alternative

AbstractBackgroundHeated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a systematic review and meta-analyses examining the efficacy and safety of HHHFNC compared with standard treatments for preterm infants. The primary outcome was the need for reintubation for preterm infants following mechanical ventilation (post-extubation analysis) or need for intubation for preterm infants not previously intubated (analysis of primary respiratory support)MethodsWe searched PubMed, MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of HHHFNC versus standard treatments. Meta-analysis was conducted using Review Manager 5.3.ResultsThe post-extubation analysis included ten RCTs (n = 1,201), and the analysis of primary respiratory support included ten RCTs (n = 1,676). There were no statistically significant differences for outcomes measuring efficacy, including the primary outcome. There were statistically significant differences favoring HHHFNC versus nasal cannula positive airway pressure (NCPAP) for air leak (post-extubation, risk ratio [RR] 0.29, 95 percent confidence interval [CI] 0.11 to 0.76, I2 = 0) and nasal trauma (post-extubation: 0.35, 95 percent CI 0.27 to 0.46, I2 = 5 percent; primary respiratory support: RR 0.52, 95 percent CI 0.37 to 0.74; I2 = 27 percent). Studies, particularly those of primary respiratory support, included very few preterm infants with gestational age (GA) <28 weeks.ConclusionsHHHFNC may offer an efficacious and safe alternative to NCPAP for some infants but evidence is lacking for preterm infants with GA ≤28 weeks.

scholarly journals Bubble CPAP (Continuous Positive airway pressure) therapy as a primary mode of respiratory support in preterm newborns with mild to moderate respiratory distress syndrome

2021 ◽  
Vol 8 (2) ◽  
pp. 94-99
Author(s):  
Dr. Sanjivani Deepak Maslekar ◽  
◽  
Dr. Somaiah G ◽  
Dr. Nagapraveen Veerapu ◽  
◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Respiratory Support ◽  
Pressure Therapy ◽  
Primary Mode ◽  
Antenatal Steroids ◽  
Bubble Cpap ◽  
Preterm Newborns

Background: Respiratory distress syndrome (RDS) is an important cause of morbidity and mortalityin preterm infants. Bubble CPAP when used appropriately, is more cost-effective, non-invasive,requires less training and has a lower risk of complications. However, not all preterm infants withRDS respond to CPAP. Aims: To study the immediate outcome of preterm infants with mild tomoderate respiratory distress syndrome on Bubble CPAP. To study the safety and effectiveness of B-CPAP and to identify the risk factors associated with its failure. Setting: NICU, Department ofpediatrics, Mamata general hospital and medical college, Khammam. Design- Prospectiveobservational study Material and Methods: This duration bound study was conducted fromFebruary 2018 to February 2020. Based on the inclusion criteria 73 Preterm babies with mild tomoderate respiratory distress syndrome requiring respiratory support were included in this study.Details of birth history, use of antenatal steroids, gestational age, type of delivery, birth weight,Downes score and chest X-ray were recorded. And the effectiveness and outcome of bubble CPAPwere studied. Results: Out of the total of 73 cases, 53(72.60%) were treated successfully, while20(27.40%) failed bubble CPAP. Conclusion: Bubble CPAP is the safe primary mode of respiratorysupport in Preterm newborns with mild to moderate RDS, more effective with early Initiation and inPreterm babies born to mothers with the use of antenatal steroids.

scholarly journals Pharmacoepidemiology of Drug Exposure in Intubated and Non-Intubated Preterm Infants With Severe Bronchopulmonary Dysplasia

2021 ◽  
Vol 12 ◽  
Author(s):  
T. Lewis ◽  
W. Truog ◽  
L. Nelin ◽  
N. Napolitano ◽  
R. L. McKinney ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Drug Exposure ◽  
Respiratory Support ◽  
Rank Test ◽  
Multiple Drug ◽  
Continuous Variables ◽  
Short Acting ◽  
Non Invasive ◽  
Drug Classes

Background: Infants with severe bronchopulmonary dysplasia (BPD) are commonly treated with off-label drugs due to lack of approved therapies. To prioritize drugs for rigorous efficacy and safety testing, it is important to describe exposure patterns in this population.Objective: Our objective was to compare rates of drug exposure between preterm infants with severe bronchopulmonary dysplasia based on respiratory support status at or beyond 36 weeks post-menstrual age.Methods: A cross-sectional cohort study was performed on October 29, 2019. Preterm infants with severe BPD were eligible and details of respiratory support and drug therapy were recorded. Wilcoxon paired signed rank test was used to compare continuous variables between the invasive and non-invasive groups. Fisher’s exact test was used to compare binary variables by respiratory support status.Results: 187 infants were eligible for the study at 16 sites. Diuretics were the drug class that most subjects were receiving on the day of study comprising 54% of the entire cohort, followed by inhaled steroids (47%) and short-acting bronchodilators (42%). Infants who were invasively ventilated (verses on non-invasive support) were significantly more likely to be receiving diuretics (p 0.013), short-acting bronchodilators (p &lt; 0.01), long-acting bronchodilators (p &lt; 0.01), systemic steroids (p &lt; 0.01), systemic pulmonary hypertension drugs (p &lt; 0.01), and inhaled nitric oxide (p &lt; 0.01).Conclusion: Infant with severe BPD, especially those who remain on invasive ventilation at 36 weeks, are routinely exposed to multiple drug classes despite insufficient pharmacokinetic, safety, and efficacy evaluations. This study helps prioritize sub-populations, drugs and drug classes for future study.

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