scholarly journals Invasive mechanical ventilation and biomarkers as predictors of bronchopulmonary dysplasia in preterm infants

2020 ◽  
Author(s):  
Camila Piqui Nascimento ◽  
Larissa Prado Maia ◽  
Patrícia Terra Alves ◽  
Aline Teodoro de Paula ◽  
Jair Pereira Cunha Junior ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Invasive Mechanical Ventilation

scholarly journals Indications for and Risks of Noninvasive Respiratory Support

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Kirsten Glaser ◽  
Clyde J. Wright
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neonatal Lung ◽  
The Individual

Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.

Duration of mechanical ventilation and neurodevelopment in preterm infants

2019 ◽  
Vol 104 (6) ◽  
pp. F631-F635 ◽  
Author(s):  
Roos J S Vliegenthart ◽  
Anton H van Kaam ◽  
Cornelieke S H Aarnoudse-Moens ◽  
Aleid G van Wassenaer ◽  
Wes Onland
Keyword(s):  
Mechanical Ventilation ◽  
Regression Analysis ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Neurodevelopmental Outcomes ◽  
Respiratory Management ◽  
Increased Risk

ObjectiveTo investigate the association between invasive mechanical ventilation (IMV) duration and long-term neurodevelopmental outcomes in preterm infants in an era of restricted IMV.DesignRetrospective cohort study.SettingSingle neonatal intensive care unit in Amsterdam.PatientsAll ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015.Main outcome measuresNeurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis.ResultsDuring the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05).ConclusionEven in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.

Nasal High-Frequency Oscillatory Ventilation in Preterm Infants with Moderate Respiratory Distress Syndrome: A Multicenter Randomized Clinical Trial

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Xingwang Zhu ◽  
Zhichun Feng ◽  
Chengjun Liu ◽  
Liping Shi ◽  
Yuan Shi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Preterm Infants ◽  
High Frequency ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Risk Difference ◽  
High Frequency Oscillatory Ventilation ◽  
High Frequency Oscillatory

<b><i>Objective:</i></b> To determine whether nasal high-frequency oscillatory ventilation (NHFOV) as a primary mode of respiratory support as compared with nasal continuous airway pressure (NCPAP) will reduce the need for invasive mechanical ventilation in preterm infants (26<sup>0/7</sup>–33<sup>6/7</sup> weeks of gestational age [GA]) with respiratory distress syndrome (RDS). <b><i>Methods:</i></b> This multicenter randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a GA of 26<sup>0/7</sup>–33<sup>6/7</sup> weeks with a diagnosis of RDS were randomly assigned to either the NCPAP (<i>n</i> = 150) or the NHFOV (<i>n</i> = 152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. <b><i>Results:</i></b> Treatment failure occurred in 15 of 152 infants (9.9%) in the ­NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (95% CI of risk difference: −15.2 to 0.4, <i>p =</i> 0.06). In the subgroup analysis, NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26<sup>+0/7</sup>–29<sup>+6/7</sup>weeks of GA (11.9 vs. 32.4%, 95% CI of risk difference: −39.3 to −1.7, <i>p =</i> 0.03) and birth weight &#x3c;1,500 g (10.4 vs. 29.6%, 95% CI of risk difference: −33.8 to −4.6, <i>p =</i> 0.01). The rate of thick secretions causing an airway obstruction was higher in the NHFOV group than in the NCPAP group (13.8 vs. 5.3%, 95% CI of risk difference: 1.9–15.1, <i>p =</i> 0.01). No significant differences in other secondary outcomes were found between the NHFOV and NCPAP groups. <b><i>Conclusions:</i></b> NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26<sup>+0/7</sup> and 33<sup>+6/7</sup> weeks of GA. In the subgroup analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants &#x3c;30 weeks of GA.

scholarly journals Determinants of preterm infants’ deaths at the Neonatal Intensive Care Units in the Northeast Countryside in Brazil

2020 ◽  
Vol 20 (2) ◽  
pp. 535-544
Author(s):  
Raquel Gomes Lima ◽  
Verônica Cheles Vieira ◽  
Danielle Souto de Medeiros
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Neonatal Period ◽  
Invasive Mechanical Ventilation ◽  
Pulmonary Hemorrhage ◽  
Neonatal Intensive Care Units ◽  
Early Weaning ◽  
Neonatal Icu

Abstract Objectives: to assess preterm infants’ characteristics, health conditions and neonatal care effect on their death at the neonatal ICU. Methods: this was a non-concurrent cohort study, including preterm infants from three neonatal ICUs from January 1st to December 31st, 2016, followed during the neonatal period and deaths registered during the entire hospitalization. Multivariate analysis was performed using Poisson regression. Results: of the 181 preterm infants, 18.8% died during hospitalization. Associated with the outcome: a gestational age between 28 and 32 weeks (RR= 5.66; CI95%= 2.08-15.40), and less than 28 weeks (RR=9.24; CI95%=3.27-26.12), Apgar score of 5th minutes less than 7 (RR: 1.82; CI95%=1.08-3.08), use of invasive mechanical ventilation up to 3 days (RR= 4.44; CI95%= 1.66-11.87) and 4 days and more (RR=6.87; CI95%=2.58-18.27). Besides the late sepsis (RR: 3.72, CI95%=1.77-7.83), acute respiratory distress syndrome (RR=2.86, CI95%=1.49-5.46), pulmonary hemorrhage (RR=1.97; CI95%=1.40-2.77), and necrotizing enterocolitis (RR= 3.41; CI95%=1.70-6.83). Conclusions: the results suggest the importance of using strategies to improve care during childbirth, conditions for extremely premature infants, early weaning from a mechanical ventilation and prevention on nosocomial infection.

scholarly journals Longitudinal assessment of the lung mechanics of very low birth weight preterm infants with and without bronchopulmonary dysplasia

2015 ◽  
Vol 133 (5) ◽  
pp. 401-407 ◽  
Author(s):  
Rosane Reis de Mello ◽  
Kátia Silveira da Silva ◽  
Anniele Medeiros Costa ◽  
José Roberto de Moraes Ramos
Keyword(s):  
Tidal Volume ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Very Low Birth Weight ◽  
Statistical Tests ◽  
Pulmonary Function Tests ◽  
Invasive Mechanical Ventilation ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Longitudinal Assessment

ABSTRACT CONTEXT AND OBJECTIVE: Prematurity has been correlated with altered lung mechanics. Some infants develop lung injury as a consequence of lung immaturity, invasive mechanical ventilation and exposure to oxygen, thus resulting in bronchopulmonary dysplasia. The aim here was to compare the lung mechanics of preterm infants with and without bronchopulmonary dysplasia during the first year of life. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: This study included premature infants at a public hospital who underwent two pulmonary function tests: one at discharge and the other at the corrected age of 4 to 8 months. Tidal volume, lung compliance and lung resistance were measured. Statistical tests were used for comparisons between infants with and without bronchopulmonary dysplasia. RESULTS: 102 children with mean gestational age of 29 ± 2.0 weeks were studied; 17 with bronchopulmonary dysplasia. Lung compliance (0.84 ± 0.29 versus 1.28 ± 0.46; P < 0.001) and tidal volume (6.1 ± 0.94 versus 7.2 ± 1.43; P < 0.01) at discharge were significant lower in children with bronchopulmonary dysplasia than in those without the disease, but no differences were observed at the second test (compliance: 1.53 ± 0.77 versus 1.94 ± 1.01; P = 0.12; and tidal volume: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSION: Differences in lung mechanics were observed between infants with and without bronchopulmonary dysplasia at hospital discharge but these differences were no longer detected at the final follow-up. The lung mechanics of all the infants improved over this period of time.

Increased circulating cytokeratin 19 fragment levels in preterm neonates receiving mechanical ventilation are associated with poor outcome

2021 ◽  
Author(s):  
Sarah Panahabadi ◽  
Katrin Heindel ◽  
Andreas Mueller ◽  
Stefan Holdenrider ◽  
Florian Kipfmueller
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Structural Integrity ◽  
Invasive Mechanical Ventilation ◽  
Total Duration ◽  
Lung Hypoplasia ◽  
Preterm Neonates ◽  
Cytokeratin 19 ◽  
Poor Outcome ◽  
Airway Injury

Invasive mechanical ventilation and oxygen toxicity are postnatal contributors to chronic lung disease of prematurity, also known as bronchopulmonary dysplasia (BPD). Cyfra 21-1 is a soluble fragment of cytokeratin 19, which belongs to the cytoskeleton stabilizing epithelial intermediate filaments. As a biomarker of structural integrity, Cyfra 21-1 might be associated with airway injury and lung hypoplasia in neonates. Serum Cyfra 21-1 concentrations for 80 preterm and 80 healthy term newborns were measured within 48 hours after birth. Preterm infants with the combined endpoint BPD/mortality had significantly higher Cyfra 21-1 levels compared to those without fulfilling BPD/mortality criteria (p=0.01). Also, severe RDS (>grade III) was associated with higher Cyfra levels (p=0.01). Total duration of oxygen therapy was more than five times longer in neonates with high Cyfra 21-1 levels (p=0.01). Infants with higher Cyfra 21-1 values were more likely to receive mechanical ventilation (50% vs. 17.5%). However the duration of mechanical ventilation was similar between groups. The median Cyfra value was 1.93 ng/ml (IQR: 1.68-2.53 ng/ml) in healthy term neonates and 8.5 ng/ml (IQR: 3.6-16.0 ng/ml) in preterm infants. Using ROC analysis, we calculated a Cyfra cutoff > 8.5 ng/ml to predict BPD/death with an AUC of 0.795 (p = 0.004), a sensitivity of 88.9% and a specificity of 55%. Mortality was predicted with a cutoff > 17.4 ng/ml (AUC: 0.94; p = 0.001), a sensitivity of 100% and a specificity of 84%. These findings suggest that Cyfra 21-1 concentration might be useful to predict poor outcome in premature infants.

scholarly journals The Impact of Postnatal Systemic Steroids on the Growth of Preterm Infants: A Multicenter Cohort Study

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2729
Author(s):  
Carlos Zozaya ◽  
Alejandro Avila-Alvarez ◽  
Fermín García-Muñoz Rodrigo ◽  
María L. Couce ◽  
Luis Arruza ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Invasive Mechanical Ventilation ◽  
Postnatal Growth ◽  
Linear Regression Models ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Major Congenital Malformations ◽  
The Impact

Postnatal steroids, often used to prevent and treat bronchopulmonary dysplasia, may influence the growth of preterm infants, although data are scarce in the literature. This is a multicenter cohort study including surviving preterm infants <32 weeks at birth (n = 17,621) from the Spanish Neonatal Network SEN1500 database, without major congenital malformations. Linear regression models were adjusted for postnatal steroids, respiratory severity course (invasive mechanical ventilation at 28 days), progression to moderate–severe bronchopulmonary dysplasia (O2 at 36 weeks), length of stay, sex, gestational age and z-scores at birth. A subgroup analysis depending on the timing of administration, ventilation status at 28 days and moderate–severe BPD diagnosis was also performed. Overall, systemic postnatal steroids were not independently associated with poorer weight gain (0.1; 95% CI: −0.05 to 0.2 g/kg/day), linear growth (0; 95% CI: −0.03 to 0.01 cm/week) or head circumference growth (−0.01; 95% CI: −0.02 to 0 cm/week). Patients who received steroids after 28 days or who were not O2 dependent at 36 weeks after having received steroids gained more weight (0.22; 95% CI: 0.04 to 0.4 and 0.2; 95% CI: 0.004 to 0.5 g/kg/day, respectively). Globally, systemic postnatal steroids had no significant adjusted effect on postnatal growth.

scholarly journals Correlation of retinopathy of prematurity with bronchopulmonary dysplasia

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Wojciech Podraza ◽  
Beata Michalczuk ◽  
Karolina Jezierska ◽  
Hanna Domek ◽  
Agnieszka Kordek ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Significant Role ◽  
Retinopathy Of Prematurity ◽  
Clinical Severity ◽  
Control Group ◽  
Study Group ◽  
Blood Transfusions ◽  
Advanced Stages

AbstractRetinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases that occur only in preterm infants. The etiology of these disorders is multifactorial; however, it is believed that some of the factors in children presenting with BPD affect both the initiation and severity of ROP. The aim of the study was to evaluate the degree of clinical severity of ROP in infants with BPD compared to those without BPD.MethodologyInfants were divided into two groups: the BPD+ study group and BPD- control group. Parameters including the incidence of ROP and its severity were compared.ResultsIn neonates with BPD, more severe forms of ROP occurred significantly more frequently than in infants without BPD. Newborns with BPD required significantly longer use of mechanical ventilation; moreover, the number of days in which the concentration of oxygen in the respiratory mixture exceeded 50% was greater in BPD+ children . Children with BPD also received more blood transfusions compared to children without BPD.ConclusionsNewborns in the BPD+ study group showed advanced stages of ROP more often than newborns in the BPD- control group. The etiology of ROP and BPD is multifactorial; however, our findings suggest oxygen plays a significant role in the development of these diseases.

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