scholarly journals Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037507
Author(s):  
Jeanie L Y Cheong ◽  
Joy E Olsen ◽  
Li Huang ◽  
Kim M Dalziel ◽  
Rosemarie A Boland ◽  
...  
Keyword(s):  
Retinopathy Of Prematurity ◽  
Periventricular Leukomalacia ◽  
Respiratory Support ◽  
Non Invasive ◽  
Discharge Home ◽  
Nasal Cannulae ◽  
Extremely Preterm ◽  
Additional Costs ◽  
Prospective Longitudinal

ObjectivesIt is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22–27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s.DesignProspective longitudinal cohort study.SettingThe State of Victoria, Australia.ParticipantsAll EP births offered intensive care in four discrete eras (1991–1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016–March 2017 (12 months): n=250).Outcome measuresConsumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated.ResultsMedian duration of any respiratory support increased from 22 days (1991–1992) to 66 days (2016–2017). The increase occurred in non-invasive respiratory support (2 days (1991–1992) to 51 days (2016–2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016–2017. Survival to discharge home increased (68% (1991–1992) to 87% (2016–2017)). Cystic periventricular leukomalacia decreased (6.3% (1991–1992) to 1.2% (2016–2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991–1992) to 10.0% (2016–2017)). The average additional costs associated with one additional infant surviving in 2016–2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991–1992, 1997 and 2005, respectively.ConclusionsConsumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined.

Respiratory outcomes in children with congenital myotonic dystrophy

2021 ◽  
pp. 1-5
Author(s):  
Jaclyn C. Omura ◽  
Maida Chen ◽  
Miriam Haviland ◽  
Susan Apkon
Keyword(s):  
Respiratory Distress ◽  
Myotonic Dystrophy ◽  
Invasive Mechanical Ventilation ◽  
Retrospective Chart Review ◽  
Mortality Rates ◽  
Respiratory Support ◽  
Non Invasive ◽  
Congenital Myotonic Dystrophy ◽  
Respiratory Outcomes

PURPOSE: Congenital myotonic dystrophy (CDM) results in hypotonia and acute respiratory distress at birth. Previous studies show that prolonged periods of intubation (>4 weeks) correlate with increased mortality rates. The objective is to describe the use and duration of respiratory support in newborns with CDM and how these relate to mortality. METHODS: A retrospective chart review was performed at a tertiary pediatric hospital among children with confirmed diagnosis of CDM. The main outcome measures were: mortality, duration of invasive mechanical ventilation (IMV) and non-invasive partial pressure ventilation (NIPPV), along with long-term use of respiratory support and equipment. RESULTS: A total of 18 subjects met inclusion criteria, 83%.f which had documented respiratory distress at birth, 39%.equired NIPPV, and 50%.equired intubation in the neonatal period. The earliest NIPPV was initiated at day one of life, and the latest extubation to NIPPV was at 17 days of life. CONCLUSION: This cohort required IMV for shorter periods with earlier transitions to NIPPV which suggests a possible change in practice and earlier transition to NIPPV recently. Further data are needed to determine if there is a possible correlation between the need for NIPPV/IMV and mortality rates.

scholarly journals A multi-institutional analysis of children on long-term non-invasive respiratory support and their outcomes

2018 ◽  
Vol 53 (4) ◽  
pp. 498-504 ◽  
Author(s):  
Monica L. Koncicki ◽  
Philip Zachariah ◽  
Adam R. Lucas ◽  
Jeffrey D. Edwards
Keyword(s):  
Institutional Analysis ◽  
Respiratory Support ◽  
Non Invasive

scholarly journals Definitions of bronchopulmonary dysplasia and long-term outcomes of extremely preterm infants in Korean Neonatal Network

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ga Won Jeon ◽  
Minkyung Oh ◽  
Yun Sil Chang
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Respiratory Support ◽  
Long Term Outcomes ◽  
Respiratory Mortality ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Original Definition

AbstractNew definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.

scholarly journals Synopsis on Non-invasive Ventilation in Neonatology

2021 ◽  
Vol 7 (04) ◽  
pp. 01-06
Author(s):  
Akshay Mehta
Keyword(s):  
Positive Airway Pressure ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Bilevel Positive Airway Pressure ◽  
Non Invasive Ventilation ◽  
Residual Capacity ◽  
Short And Long Term

Non-invasive ventilation (NIV) is a mode of respiratory support commonly used on the neonatal unit. Since the advent of NIV, it has evolved from being used as a mode of respiratory support to wean infants from mechanical ventilation (MV) to a primary mode of respiratory support. NIV improve the functional residual capacity in the newborn (at term or preterm) avoiding invasive actions such as tracheal intubation. Newer methods of NIV support such as nasal bilevel positive airway pressure (BiPAP) and humidified high flow nasal cannula oxygen therapy (HHFNC) have emerged in attempts to reduce intubation rates and subsequent MV in preterm infants. With this synopsis, we aim to discuss various available NIV modes of ventilation in Neonatology, including indications, physiological principle, practical aspects and effects on important short and long-term morbidities associated with the use of NIV.

Sleep studies in children on long-term non-invasive respiratory support

2014 ◽  
Vol 18 (4) ◽  
pp. 885-889 ◽  
Author(s):  
John A Widger ◽  
Margot J Davey ◽  
Gillian M Nixon
Keyword(s):  
Respiratory Support ◽  
Non Invasive ◽  
Sleep Studies

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.

Improving Feeding Outcomes in the NICU: Moving From Volume-Driven to Infant-Driven Feeding

2010 ◽  
Vol 19 (3) ◽  
pp. 68-74 ◽  
Author(s):  
Catherine S. Shaker
Keyword(s):  
Intensive Care Unit ◽  
Dynamic Systems ◽  
Neonatal Intensive Care ◽  
Well Being ◽  
Dynamic Systems Theory ◽  
Feeding Problems ◽  
Care Giving ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Current research on feeding outcomes after discharge from the neonatal intensive care unit (NICU) suggests a need to critically look at the early underpinnings of persistent feeding problems in extremely preterm infants. Concepts of dynamic systems theory and sensitive care-giving are used to describe the specialized needs of this fragile population related to the emergence of safe and successful feeding and swallowing. Focusing on the infant as a co-regulatory partner and embracing a framework of an infant-driven, versus volume-driven, feeding approach are highlighted as best supporting the preterm infant's developmental strivings and long-term well-being.

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