scholarly journals Effect of oxygen saturation targets on the incidence of bronchopulmonary dysplasia and duration of respiratory supports in extremely preterm infants

2019 ◽  
Vol 25 (3) ◽  
pp. 173-179
Author(s):  
Youstina Hanna ◽  
Corinne Laliberté ◽  
Nadya Ben Fadel ◽  
Brigitte Lemyre ◽  
Bernard Thébaud ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Extremely Preterm ◽  
Lower Oxygen ◽  
Secondary Outcomes ◽  
The Difference

Abstract Background Recent clinical practice changes in neonatal care resulted in higher, narrower oxygen saturation target ranges for preterm infants. The effect of targeting higher or lower oxygen saturations on respiratory outcomes of preterm infants and duration of hospitalization has not been extensively reviewed in the context of current care, but could have significant implications. Methods A multicentre retrospective cohort of 145 preterm infants was conducted; 105 had lower oxygen saturation targets (88 to 92%), 40 had higher targets (90 to 95%). The primary outcome was bronchopulmonary dysplasia (BPD). Secondary outcomes included duration of invasive/noninvasive respiratory support, oxygen therapy, and hospitalization. The primary outcome was compared using Fisher’s exact test. Secondary outcomes were evaluated with survival analysis and Wilcoxon rank sum test. Results The difference in incidence of BPD in the lower (N=56, 53.3%) and higher saturation groups (N=14, 35.0%) was not statistically significant (relative risk [RR]=0.66 [0.41, 1.04], P=0.06). The difference in duration of mechanical ventilation in the lower (median 7.8 days, interquartile range [IQR] 3.7 to 15.9) and higher saturation groups (median 4.5, IQR 1.9 to 12.3) approached statistical significance (P=0.05). There were no statistically significant differences in the durations of other respiratory supports or hospital stay between the two groups. Conclusions The results of this study approached statistical significance and suggest that higher, narrower oxygen saturation targets may result in a clinically important reduction in BPD incidence and duration of mechanical ventilation. These results require validation in a larger sample to refine optimal targets.

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.

scholarly journals Protocol for a randomised controlled trial comparing two CPAP levels to prevent extubation failure in extremely preterm infants

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045897
Author(s):  
Anna Madeline Kidman ◽  
Brett James Manley ◽  
Rosemarie Anne Boland ◽  
Atul Malhotra ◽  
Susan M Donath ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomised Controlled Trial ◽  
Preterm Infants ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Extubation Failure ◽  
Intention To Treat ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Randomised Controlled

IntroductionRespiratory distress syndrome is a complication of prematurity and extremely preterm infants born before 28 weeks’ gestation often require endotracheal intubation and mechanical ventilation. In this high-risk population, mechanical ventilation is associated with lung injury and contributes to bronchopulmonary dysplasia. Therefore, clinicians attempt to extubate infants as quickly and use non-invasive respiratory support such as nasal continuous positive airway pressure (CPAP) to facilitate the transition. However, approximately 60% of extremely preterm infants experience ‘extubation failure’ and require reintubation. While CPAP pressures of 5–8 cm H2O are commonly used, the optimal CPAP pressure is unknown, and higher pressures may be beneficial in avoiding extubation failure. Our trial is the Extubation CPAP Level Assessment Trial (ÉCLAT). The aim of this trial is to compare higher CPAP pressures 9–11 cm H2O with a current standard pressures of 6–8 cmH2O on extubation failure in extremely preterm infants.Methods and analysis200 extremely preterm infants will be recruited prior to their first extubation from mechanical ventilation to CPAP. This is a parallel group randomised controlled trial. Infants will be randomised to one of two set CPAP pressures: CPAP 10 cmH2O (intervention) or CPAP 7 cmH2O (control). The primary outcome will be extubation failure (reintubation) within 7 days. Statistical analysis will follow standard methods for randomised trials on an intention to treat basis. For the primary outcome, this will be by intention to treat, adjusted for the prerandomisation strata (GA and centre). We will use the appropriate parametric and non-parametric statistical tests.Ethics and disseminationEthics approval has been granted by the Monash Health Human Research Ethics Committees. Amendments to the trial protocol will be submitted for approval. The findings of this study will be written into a clinical trial report manuscript and disseminated via peer-reviewed journals (on-line or in press) and presented at national and international conferences.Trial registration numberACTRN12618001638224; pre-results.

The effect of postnatal corticosteroids on growth parameters in infants with bronchopulmonary dysplasia

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emma E. Williams ◽  
Theodore Dassios ◽  
Mikhaela Mann ◽  
Anne Greenough
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Head Circumference ◽  
Neonatal Intensive Care ◽  
Growth Parameters ◽  
Corticosteroid Treatment ◽  
Postnatal Growth ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Difference

Abstract Objectives Corticosteroids are administered to ventilator dependent infants with bronchopulmonary dysplasia (BPD) to improve respiratory function and facilitating extubation. Acutely, however, growth impairment can occur as a side effect of such therapy. We aimed to determine the effect of corticosteroids on postnatal growth during the entire neonatal intensive care unit (NICU) admission. Methods A whole population study of extremely preterm infants with BPD was undertaken. Corticosteroid therapy was classified as treatment with dexamethasone or hydrocortisone for a least five consecutive days. Growth was calculated as the difference in weight and head circumference z-score from birth to discharge. Results Six thousand, one hundred and four infants with BPD were included of whom 28.3% received postnatal corticosteroids. Infants receiving corticosteroids were less mature (GA 25.0 vs. 26.3 weeks) and of lower birthweight (0.70 vs. 0.84 kg) than those not receiving treatment. There were no significant differences between those who did and did not receive corticosteroids in weight gain (p=0.61) or head circumference growth (p=0.33) from birth to discharge. Single vs. multiple courses of postnatal corticosteroids did not result in significant differences in weight (p=0.62) or head circumference (p=0.13) growth. Conclusions Postnatal corticosteroid treatment did not affect the longer term growth of preterm infants with BPD.

scholarly journals Influence Of Time Under Mechanical Ventilation On Bronchopulmonary Dysplasia Severity In Extremely Preterm Infants: A Pilot Study.

2020 ◽  
Author(s):  
Vanessa Suziane Probst ◽  
Victoria Escobar ◽  
Darllyana Soares ◽  
Jane Kreling ◽  
Ligia Ferrari ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Roc Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Chi Square ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD (M/S BPD) in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and M/S BPD. Methods: 53 PTNB were separated into mild and M/S BPD groups and their data were analyzed. Time under MV with a greater chance of developing M/S BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to M/S BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-square test. Results: Time under MV related to a greater chance of developing M/S BPD was 36 days. M/S BPD group had more males (14 vs 5, p=0,047), longer time under MV (43 vs 19 days, p<0,001), more individuals with PH (12 vs 3, p=0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p=0,003), longer hospital length of stay (109 vs 81,5 days, p<0,001), greater PMA (41 vs 38 weeks, p<0,001) and weight (2620 vs 2031 grams, p<0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p=0,043). Among all variables included in logistic regression, only PH and MV<36 days were significant in the model, explaining 72% of variation in M/S BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the M/S BPD group was 100% (n=6) and 0% in mild BPD group (p=0,0001). Conclusion: Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of M/S BPD.

scholarly journals Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Victoria Escobar ◽  
Darllyana S. Soares ◽  
Jane Kreling ◽  
Ligia S. L. Ferrari ◽  
Josiane M. Felcar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pilot Study ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Influence of Time Under Mechanical Ventilation on Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants: A Pilot Study.

2020 ◽  
Author(s):  
Victoria Escobar ◽  
Darllyana Soares ◽  
Jane Kreling ◽  
Ligia Ferrari ◽  
Josiane M. Felcar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Roc Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Common Disease ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background: The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. Methods: 53 PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-square test. Results: Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p=0,047), longer time under MV (43 vs 19 days, p<0,001), more individuals with PH (12 vs 3, p=0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p=0,003), longer hospital length of stay (109 vs 81,5 days, p<0,001), greater PMA (41 vs 38 weeks, p<0,001) and weight (2620 vs 2031 grams, p<0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p=0,043). Among all variables included in logistic regression, only PH and MV<36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n=6) and 0% in mild BPD group (p=0,0001). Conclusion: Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.

Delayed cord clamping in infants born less than 35 weeks: A retrospective study

2020 ◽  
pp. 1-5
Author(s):  
N. Singh ◽  
D. Brammer
Keyword(s):  
Retrospective Study ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Primary Outcome ◽  
Practice Variation ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Difference

BACKGROUND: Evidence supports delayed cord clamping (DCC) in preterm infants. However, practice variation exists, and many preterm infants do not receive DCC despite multiple benefits and lack of harm. We aim to 1) study the rate of DCC in preterm infants, 2) compare the difference between infants who received DCC and those who did not receive DCC and 3) investigate the reasons for not performing DCC. METHODS: We conducted this retrospective study to evaluate DCC practice at our institution since its implementation in September 2015. We collected and analyzed the data on DCC of 30–45 sec duration in inborn infants <  35 weeks gestation admitted to the neonatal intensive care unit from June 2016- June 2019. The primary outcome was the rate of delayed cord clamping. RESULTS: Of the 447 infants, 275 (62%) received DCC. The rate of DCC was 36% , 54% , and 66% in infants <  27 weeks, 27–29 weeks and >  30 weeks gestation, respectively (p = 0.001). Infants not receiving DCC were smaller, of lower gestational age, and more likely to be delivered via cesarean section than those who received DCC (p <  0.0001). Infants not receiving DCC had a higher rate of receiving PPV or intubation and a 1minute Apgar score of <  5 compared to those receiving DCC. We could not establish the reason for not performing DCC because of inadequate documentation in the medical records. CONCLUSIONS: The rate of DCC is low in clinical practice, in particular among extremely preterm infants.

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