PULMONARY MECHANICS, CHEST X-RAY AND LUNG DISEASE AFTER MECHANICAL VENTILATION IN LOW BIRTH WEIGHT INFANTS

The improvement in survival in premature infants associated with the evolution of mechanical ventilation has been accompanied by an increase in ventilator induced lung injury. High frequency ventilation has been shown to reduce the incidence of ventilator induced lung injury and hence chronic lung disease in the very low birth weight infant. The evolution in understanding how to best use high frequency ventilation in this population has prompted us to ask whether similar strategies to optimize lung volumes on conventional mechanical ventilation can minimize chronic lung disease in the neonate. We retrospectively reviewed the medical charts of 51 extremely low birth weight infants born in Kingston, Ontario in two epochs, 1990 to 1991 and 1999 to 2000, for ventilatory strategy and outcome. From our review, it is clear that surfactant therapy rapidly changes lung mechanics by improving pulmonary compliance and that lung damage may result if there are not changes in the ventilatory management to reflect the altered compliance. Early ventilation strategies during the apparently stable "honeymoon period" in a patient with respiratory distress syndrome (RDS) has significant implications on long term morbidity. In the era prior to the use of surfactant, 30% of infants died and 40% developed chronic lung disease (CLD). Immediately following the use of surfactant, mortality was reduced to 18%, however, the incidence of CLD increased to 78%. In the most recent era, following 10 years of experience with surfactant and mechanical ventilation, morbidity was 17% and CLD 21%. This study demonstrates that a particularly crucial time is in the immediate period following surfactant administration. The use of lower peak inspiratory pressure (PIP) and mean airway pressure (MAP) over the first 24 hours and an increase in the use of synchronous intermittent mandatory ventilation (SIMV) was associated with an improved outcome. The challenge remaining is to determine how to best utilize a conventional mode of ventilation to best optimize lung volume and protect the immature lung.

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High-Frequency Oscillation and Chronic Lung Disease in Very Low Birth Weight Infants

PEDIATRICS ◽

10.1542/peds.108.1.212 ◽

2001 ◽

Vol 108 (1) ◽

pp. 212-214

Author(s):

J. P. Shenai; ◽

P. Rimensberger; ◽

U. Thome ◽

F. Pohlandt; ◽

P. Rimensberger

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Lung Disease ◽

Chronic Lung Disease ◽

High Frequency ◽

Very Low Birth Weight ◽

High Frequency Oscillation ◽

Frequency Oscillation ◽

Low Birth Weight Infants

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Faculty Opinions recommendation of Effects of Multiple Ventilation Courses and Duration of Mechanical Ventilation on Respiratory Outcomes in Extremely Low-Birth-Weight Infants.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725821841.793530824 ◽

2017 ◽

Author(s):

Vineet Bhandari

Keyword(s):

Mechanical Ventilation ◽

Birth Weight ◽

Low Birth Weight ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Respiratory Outcomes

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The Effect of the National Shortage of Vitamin A on Death or Chronic Lung Disease in Extremely Low-Birth-Weight Infants

JAMA Pediatrics ◽

10.1001/jamapediatrics.2014.1353 ◽

2014 ◽

Vol 168 (11) ◽

pp. 1039 ◽

Cited By ~ 17

Author(s):

Veeral N. Tolia ◽

Karna Murthy ◽

Pam S. McKinley ◽

Monica M. Bennett ◽

Reese H. Clark

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Vitamin A ◽

Lung Disease ◽

Chronic Lung Disease ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants

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Is Chronic Lung Disease in Low Birth Weight Infants Preventable? A Survey of Eight Centers

PEDIATRICS ◽

10.1542/peds.79.1.26 ◽

1987 ◽

Vol 79 (1) ◽

pp. 26-30 ◽

Cited By ~ 38

Author(s):

Mary Ellen Avery ◽

William H. Tooley ◽

Jacob B. Keller ◽

Suzanne S. Hurd ◽

M. Heather Bryan ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Lung Disease ◽

San Francisco ◽

Chronic Lung Disease ◽

Multivariate Logistic Regression Analysis ◽

Low Birth Weight Infants ◽

Relationship Of ◽

The Relationship ◽

Prematurely Born Infants

Chronic lung disease in prematurely born infants, defined as the need for increased inspired oxygen at 28 days of age, was thought to be more common in some institutions than in others. To test this hypothesis, we surveyed the experience in the intensive care nurseries at Columbia and Vanderbilt Universities, the Universities of Texas at Dallas, Washington at Seattle, and California at San Francisco, the Brigham and Women's Hospital in Boston, Texas Children's Hospital in Houston, and Mt Sinai Hospital in Toronto. The survey included 1,625 infants with birth weights of 700 to 1,500 g. We confirmed the relationship of risk to low birth weight, white race, and male sex. Significant differences in the incidence of chronic lung disease were found between institutions even when birth weight, race, and sex were taken into consideration through a multivariate logistic regression analysis. Columbia had one of the best outcomes for low birth weight infants and the lowest incidence of chronic lung disease.

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