Duration of and trends in respiratory support among extremely preterm infants

2020 ◽  
pp. fetalneonatal-2020-319496
Author(s):  
Dany E Weisz ◽  
Eugene Yoon ◽  
Michael Dunn ◽  
Julie Emberley ◽  
Amit Mukerji ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Resource Planning ◽  
Cox Proportional Hazards ◽  
Respiratory Support ◽  
Low Flow ◽  
Positive Pressure ◽  
Surfactant Treatment ◽  
Non Invasive ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

ObjectiveTo evaluate annual trends in the administration and duration of respiratory support among preterm infants.DesignRetrospective cohort study.SettingTertiary neonatal intensive care units in the Canadian Neonatal Network.Patients8881 extremely preterm infants born from 2010 to 2017 treated with endotracheal and/or non-invasive positive pressure support (PPS).Main outcome measuresCompeting risks methods were used to investigate the outcomes of mortality and time to first successful extubation, definitive extubation, weaning off PPS, and weaning PPS and/or low-flow oxygen, according to gestational age (GA). Cox proportional hazards and regression models were fitted to evaluate the trend in duration of respiratory support, survival and surfactant treatment over the study period.ResultsThe percentages of infants who died or were weaned from respiratory support were presented graphically over time by GA. Advancing GA was associated with ordinally earlier weaning from respiratory support. Year over year, infants born at 23 weeks were initially and definitively weaned from endotracheal and all PPS earlier (HR 1.06, 95% CI 1.01 to 1.11, for all outcomes), while survival simultaneously increased (OR 1.11, 95% CI 1.03 to 1.18). Infants born at 26 and 27 weeks remained on non-invasive PPS longer (HR 0.97, 95% CI 0.95 to 0.98 and HR 0.97, 95% CI 0.95 to 0.99, respectively). Early surfactant treatment declined among infants born at 24–27 weeks GA.ConclusionsInfants at the borderline of viability have experienced improved survival and earlier weaning from all forms of PPS, while those born at 26 and 27 weeks are spending more time on PPS in recent years. GA-based estimates of the duration of respiratory support and survival may assist in counselling, benchmarking, quality improvement and resource planning.

Initiation of respiratory support for extremely preterm infants at birth

2020 ◽  
pp. fetalneonatal-2020-319798
Author(s):  
Madeleine C Murphy ◽  
Lisa K McCarthy ◽  
Colm P F O’Donnell
Keyword(s):  
Preterm Infants ◽  
Low Birthweight ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Neonatal Resuscitation ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Extremely Low Birthweight

Neonatal resuscitation algorithms recommend assessing breathing and heart rate (HR) of newborns and giving respiratory support when one or both are unsatisfactory. Recommendations also state that preterm infants may be supported with continuous positive airway pressure rather than routinely intubated for positive pressure ventilation (PPV). We wished to describe the prevalence and time of initiation of respiratory support of extremely preterm and extremely low birthweight (ELBW) infants at our hospital. We reviewed videos of 55 infants. Although most were breathing, practically all newly born extremely preterm ELBW infants were given respiratory support soon after arrival to the resuscitation cot. For the majority, this was done without knowing the HR. The majority received PPV; again, this was often done without knowing the HR. A quarter of infants were managed without any PPV.

scholarly journals Discrepancy between invasive and non-invasive blood pressure readings in extremely preterm infants in the first four weeks of life

PLoS ONE ◽  
2018 ◽  
Vol 13 (12) ◽  
pp. e0209831 ◽  
Author(s):  
Tobias Werther ◽  
Lukas Aichhorn ◽  
Sigrid Baumgartner ◽  
Angelika Berger ◽  
Katrin Klebermass-Schrehof ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Preterm Infants ◽  
Invasive Blood Pressure ◽  
Non Invasive ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals CEREBRAL OXYGENATION AND PERIPHERAL OXIMETRY IN EXTREMELY PRETERM INFANTS WITH PULMONARY AND/OR CEREBRAL INTRAVENTRICULAR HEMORRHAGE IN THE FIRST 72 HOURS OF LIFE

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e22-e23
Author(s):  
Thierry Beausoleil ◽  
Marie Janaillac ◽  
Keith Barrington ◽  
Marie-Josée Raboisson ◽  
Oliver Karam ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Preterm Infants ◽  
Premature Infants ◽  
Cross Correlation ◽  
Cerebral Oxygenation ◽  
Invasive Monitoring ◽  
Time Frequency ◽  
Non Invasive ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract BACKGROUND Extremely premature infants born <28 weeks of gestation are at higher risk of pulmonary (PH) and cerebral intraventricular (IVH) hemorrhage due to immature cardiovascular and transitioning physiology. Non-invasive monitoring has the potential to detect early abnormal circulation. OBJECTIVES To explore time-frequency relationships between cerebral oxygenation and peripheral oximetry. DESIGN/METHODS Near infrared spectroscopy cerebral regional haemoglobin oxygen saturation (CrSO2), preductal peripheral perfusion index (PI), heart rate (HR), capillary oxygen saturation (SpO2), and blood pressure (BP) were monitored in the first 72h of life. Patients were grouped in infants with PH and/or IVH (n=8) and controls (n=10). Signals were decomposed in wavelets allowing the analysis of localized variations of power. This approach allowed to quantify the common power and determine the duration of significant cross-correlation, phase and coherence between each pair of signals. Groups were compared with Wilcoxon tests. RESULTS Figure 1 shows an example of CrSO2 and PI, and their cross-correlation, phase (semblance) and coherence in a control (left column) and a PH-IVH patient (right column). Durations of significant cross-correlation between CrSO2 and HR (p<0.01), and CrSO2 and SpO2 (p=0.02) were significantly lower in PH-IVH infants compared to controls. The duration of significant anti-phase between CrSO2 and SpO2 (p=0.01) and the duration of significant coherence between PI and BP (p=0.03) were also significantly lower in PH-IVH infants compared to controls. These differences may indicate a disruption in auto-regulation, which is currently incompletely understood in this population. CONCLUSION This study is the first to apply time-frequency analysis to simultaneous NIRS and preductal peripheral oximetry in extremely preterm infants early in life. Significantly lower durations of cross-correlation (CrSO2 with HR and SpO2), anti-phase (CrSO2, SpO2) and coherence (PI, BP) in PH-IVH patients may reflect early abnormal circulation. Our results show the potential of non-invasive monitoring to identify premature infants at-risk of early PH-IVH.

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.

Chronic Inflammatory Placental Lesions Correlate With Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants

2021 ◽  
pp. 109352662110136
Author(s):  
Amit Sharma ◽  
Beena G Sood ◽  
Faisal Qureshi ◽  
Yuemin Xin ◽  
Suzanne M Jacques
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Group Development ◽  
Respiratory Support ◽  
Placental Pathology ◽  
Inflammatory Lesions ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Objective Correlation of BPD with placental pathology is important for clarification of the multifactorial pathogenesis of BPD; however, previous reports have yielded varying results. We report placental findings in no/mild BPD compared to moderate/severe BPD, and with and without pulmonary hypertension (PH). Methods Eligible infants were 230/7-276/7 weeks gestational age. BPD was defined by the need for oxygen at ≥28 days with severity based on need for respiratory support at ≥36 weeks. Acute and chronic inflammatory placental lesions and lesions of maternal and fetal vascular malperfusion were examined. Results Of 246 eligible infants, 146 (59%) developed moderate/severe BPD. Thirty-four (23%) infants developed PH, all but 1 being in the moderate/severe BPD group. Chronic deciduitis (32% vs 16%, P = .003), chronic chorioamnionitis (23% vs 12%, P = .014), and ≥ 2 chronic inflammatory lesions (13% vs 3%, P = .007) were more frequent in the moderate/severe BPD group. Development of PH was associated with placental villous lesions of maternal vascular malperfusion (30% vs 15%, P = .047). Conclusions The association of chronic inflammatory placental lesions with BPD severity has not been previously reported. This supports the injury responsible for BPD as beginning before birth in some neonates, possibly related to cytokines associated with these chronic inflammatory lesions.

Respiratory support

2017 ◽  
Author(s):  
Grenville Fox ◽  
Nicholas Hoque ◽  
Timothy Watts
Keyword(s):  
High Frequency ◽  
Positive Pressure Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Respiratory Support ◽  
Low Flow ◽  
Positive Pressure ◽  
Respiratory Problems ◽  
Non Invasive ◽  
European Consensus ◽  
High Frequency Oscillatory

This chapter includes sections on various modes of both invasive (i.e. via an endotracheal tube) and non-invasive respiratory support in neonates, including conventional ventilation, volume-targeted ventilation, high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), nasal continuous positive airways pressure (nCPAP), nasal intermittent positive pressure ventilation (nIPPV), and high and low-flow nasal cannula oxygen. There is also a brief section on the care of babies with a tracheostomy as well as management of babies requiring home oxygen. Reference is made to the most recent European Consensus Guidelines. A separate chapter on neonatal respiratory problems (Chapter 7) gives further detail on common lung pathologies requiring respiratory support in neonates.

scholarly journals Extubation generates lung volume inhomogeneity in preterm infants

2021 ◽  
pp. fetalneonatal-2021-321788
Author(s):  
Risha Bhatia ◽  
Hazel R Carlisle ◽  
Ruth K Armstrong ◽  
C Omar Farouk Kamlin ◽  
Peter G Davis ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Lung Volume ◽  
Neonatal Intensive Care ◽  
Prospective Observational Study ◽  
Applied Pressure ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Impedance Tomography ◽  
Non Invasive ◽  
Volume Inhomogeneity

ObjectiveTo evaluate the feasibility of electrical impedance tomography (EIT) to describe the regional tidal ventilation (VT) and change in end-expiratory lung volume (EELV) patterns in preterm infants during the process of extubation from invasive to non-invasive respiratory support.DesignProspective observational study.SettingSingle-centre tertiary neonatal intensive care unit.PatientsPreterm infants born <32 weeks’ gestation who were being extubated to nasal continuous positive airway pressure as per clinician discretion.InterventionsEIT measurements were taken in supine infants during elective extubation from synchronised positive pressure ventilation (SIPPV) before extubation, during and then at 2 and 20 min after commencing nasal continuous positive applied pressure (nCPAP). Extubation and pressure settings were determined by clinicians.Main outcome measuresGlobal and regional ΔEELV and ΔVT, heart rate, respiratory rate and oxygen saturation were measured throughout.ResultsThirty infants of median (range) 2 (1, 21) days were extubated to a median (range) CPAP 7 (6, 8) cm H2O. SpO2/FiO2 ratio was a mean (95% CI) 50 (35, 65) lower 20 min after nCPAP compared with SIPPV. EELV was lower at all points after extubation compared with SIPPV, and EELV loss was primarily in the ventral lung (p=0.04). VT was increased immediately after extubation, especially in the central and ventral regions of the lung, but the application of nCPAP returned VT to pre-extubation patterns.ConclusionsEIT was able to describe the complex lung conditions occurring during extubation to nCPAP, specifically lung volume loss and greater use of the dorsal lung. EIT may have a role in guiding peri-extubation respiratory support.

scholarly journals Cardiorespiratory effects of NIV-NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: a randomized crossover trial

2021 ◽  
Author(s):  
Samantha Latremouille ◽  
Monica Bhuller ◽  
Wissam Shalish ◽  
Guilherme Sant'Anna
Keyword(s):  
Airway Pressure ◽  
Crossover Trial ◽  
Mode Analysis ◽  
Positive Pressure ◽  
Neurally Adjusted Ventilatory Assist ◽  
Full Data ◽  
Non Invasive ◽  
Randomized Crossover Trial ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Objective: Investigate the cardiorespiratory effects of non-invasive neurally adjusted ventilatory assist (NIV-NAVA), non-synchronized nasal intermittent positive pressure ventilation (NIPPV), and nasal continuous positive airway pressure (NCPAP) during the critical period shortly after extubation. Hypothesis: Levels of non-invasive pressure support provided and/or presence of synchronization can affect cardiorespiratory parameters. Study design: Randomized crossover trial. Patient-subject selection: Infants with birth weight (BW) ≤ 1250g undergoing their first planned extubation were randomly assigned to all 3 modes following extubation. Methodology: Electrocardiogram and electrical activity of the diaphragm (Edi) were recorded during 30min on each mode. Analysis of heart rate variability (HRV), diaphragmatic activity (Edi area, breath area, amplitude, inspiratory and expiratory times) and respiratory variability (RV) were compared between modes. Results: 23 enrolled infants had full data recordings and analysis: median [IQR] gestational age = 25.9 weeks [25.2-26.4], BW = 760g [595-900], and post-natal age 7 [4-19] days. There were no differences in HRV parameters between modes. During NIV-NAVA and NIPPV, diaphragmatic activity was significantly lower and RV higher than NCPAP. Delivered peak inflation pressures (PIPs) were lower during NIV-NAVA than NIPPV (14 cmH2O [13-16] vs cmH2O 16 [16-17]; p<0.001). However, due to a significantly higher proportion of assisted breaths (99% [92-103] vs. 51% [38-82]; p<0.001) NIV-NAVA provided a higher mean airway pressure (MAP)(9.4 cmH2O [8.2-10.0] vs. 8.2 cmH2O [7.6-9.3]; p=0.002). Conclusions: NIV-NAVA and NIPPV applied shortly after extubation were associated with positive cardiorespiratory effects. This effect was more evident during NIV-NAVA where patient-ventilator synchronization provided a higher MAP with lower PIPs.

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