Lost in Transition: Is Early Respiratory Support in Newborn Infants the Best Option?

Neonatology ◽  
2020 ◽  
Vol 117 (4) ◽  
pp. 517-521
Author(s):  
Adam Buckmaster ◽  
Gaston Arnolda ◽  
Louise Owen ◽  
Calum Roberts ◽  
Peter Davis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Treatment Failure ◽  
Newborn Infants ◽  
Supplemental Oxygen ◽  
Late Preterm ◽  
Respiratory Support ◽  
Severe Illness ◽  
Intravenous Fluids ◽  
Using Data

<b><i>Background:</i></b> Late preterm and term newborns with respiratory distress are increasingly treated with non-invasive ventilation (NIV) including nasal high-flow or continuous positive airway pressure. For infants with mild distress, NIV may be unnecessary. <b><i>Objectives:</i></b> We speculated that treatment with supplemental oxygen (SO) prior to NIV could help clinicians select infants for NIV treatment, and examined this hypothesis using data from a recently completed trial. <b><i>Method:</i></b> Post hoc analysis of data from a subset of infants enrolled in the HUNTER trial. Infants born at ≥36 weeks’ gestation were categorized by whether they were receiving SO prior to randomization. The 2 groups were compared for illness severity (indicated by treatment failure at 72 h, mechanical ventilation, need for up-transfer, SO requirement post-randomization, and length of time receiving respiratory support), use of selected medical interventions (antibiotics, intravenous fluids), and breastfeeding at discharge. <b><i>Results:</i></b> Analysis included 380 infants. Infants not receiving SO had less severe illness; lower rates of treatment failure (7.3 vs. 17.2%), mechanical ventilation (0.6 vs. 5.9%), need for transfer (6.8 vs. 13.8%), and more often did not receive any SO post-randomization (75.1 vs. 3.0%). Most infants in both groups received intravenous fluids (93 and 98%) and antibiotics (81 and 93%); the rate of full breastfeeding was low in both groups (51 and 45%). <b><i>Conclusions:</i></b> Late preterm and term newborn infants without SO requirement at the time of commencing NIV for respiratory distress are at lower risk of requiring treatment escalation. Close observation of these infants (watch and wait strategy) may avoid unnecessary treatment.

scholarly journals Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress

2020 ◽  
Vol 61 (2) ◽  
pp. 174-179
Author(s):  
Won Young Lee ◽  
Eui Kyung Choi ◽  
Jeonghee Shin ◽  
Eun Hee Lee ◽  
Byung Min Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Distress ◽  
Treatment Failure ◽  
Newborn Infants ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula

Spontaneous Pneumomediastinum: Uncommon Cause of Air Leak in Late Preterm Neonate

2021 ◽  
Vol 35 (2) ◽  
pp. 93-94
Author(s):  
Jyotsna Bhushan ◽  
Shagufta Iqbal ◽  
Abhishek Chopra
Keyword(s):  
Respiratory Distress ◽  
Conservative Management ◽  
Preterm Neonate ◽  
Late Preterm ◽  
Intravenous Fluids ◽  
X Rays ◽  
Blood Gas ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Chest X Ray

A clinical case report of spontaneous pneumomediastinum in a late-preterm neonate, chest x-ray showing classical “spinnaker sail sign,” which was managed conservatively and had excellent prognosis on conservative management. Respiratory distress in a preterm neonate is a common clinical finding. Common causes include respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax. Pneumomediastinum is not very common cause of respiratory distress and more so spontaneous pneumomediastinum. We report here a preterm neonate with spontaneous pneumomediastinum who had excellent clinical recovery with conservative management. A male baby was delivered to G3P1A1 mother at 34 + 6 weeks through caesarean section done due to abruptio placenta. Apgar scores were 8 and 9. Maternal antenatal history was uneventful and there were no risk factors for early onset sepsis. Baby had respiratory distress soon after birth with Silverman score being 2/10. Baby was started on oxygen (O2) by nasal prongs through blender 0.5 l/min, FiO2 25%, and intravenous fluids. Blood gas done was normal. Possibility of transient tachypnea of newborn or mild hyaline membrane disease was kept. Respiratory distress increased at 20 h of life (Silverman score: 5), urgent chest x-ray done revealed “spinnaker sign” suggestive of pneumomediastinum, so baby was shifted to O2 by hood with FiO2 being 70%. Blood gas repeated was normal. Baby was managed conservatively on intravenous fluids and O2 by hood. Baby was gradually weaned off from O2 over next 5 days. As respiratory distress decreased, baby was started on orogastric feed, which baby tolerated well and then was switched to oral feeds. Serial x-rays showed resolution of pneumomediastinum. Baby was discharged on day 7 of life in stable condition on breast feeds and room air.

scholarly journals Pulmonary air leak syndrome in term and late preterm neonates

2019 ◽  
Vol 147 (9-10) ◽  
pp. 578-582
Author(s):  
Gordana Markovic-Sovtic ◽  
Tatjana Nikolic ◽  
Aleksandar Sovtic ◽  
Jelena Martic ◽  
Zorica Rakonjac
Keyword(s):  
Mechanical Ventilation ◽  
Medical Center ◽  
Perinatal Asphyxia ◽  
Late Preterm ◽  
Respiratory Support ◽  
Medical Emergency ◽  
Preterm Neonates ◽  
Air Leak ◽  
Average Birth Weight ◽  
Air Leak Syndrome

Introduction/Objective. Air leak syndrome is more frequent in neonatal period than at any other period of life. Its timely recognition and treatment is a medical emergency. We present results of a tertiary medical center in treatment of air leak syndrome in term and late preterm neonates. Methods. Neonates born between 34th 0/7 and 41st 6/7 gestational weeks (g.w.) who were treated for air leak syndrome in the Neonatal Intensive Care Unit of Mother and Child Health Care Institute, from 2005 to 2015 were included in the study. Antropometric data, perinatal history, type of respiratory support prior to admission, chest radiography, type of pulmonary air leak syndrome and its management, underlying etiology, and final outcome were analyzed. Results. Eighty-seven neonates of an average gestational age 38.1 ? 1.9 g.w. were included in the study. The average birth weight was 3182.5 ? 55.5 g. Fourty-seven (54%) were born by cesarean section and 40 (46%) were born by vaginal delivery. Prior to admission, 62.1% received supplemental oxygen, 4.6% were on nasal continuous positive airway pressure, and 21.8% were on conventional mechanical ventilation. Type of delivery did not significantly affect the appearance of pneumothorax, nor did the type of respiratory support received prior to admission (p > 0.05). The majority (93.1%) had pneumothorax, which was unilateral in 79%. The length of mechanical ventilation significantly affected the appearance of pneumothorax (p = 0.015). Low Apgar score in the first minute and the presence of pneumopericardium were significant factors predisposing for an unfavorable outcome. Conclusion. Improving mechanical ventilation strategies and decreasing the rate of perinatal asphyxia in term and late preterm neonates could diminish the incidence of pulmonary air leak syndrome in this age group.

scholarly journals Mechanical Ventilation of Newborn Infants I. The Effect of Rate and Pressure on Arterial Oxygenation of Infants with Respiratory Distress Syndrome

1969 ◽  
Vol 3 (3) ◽  
pp. 244-254 ◽  
Author(s):  
Penelope Cave Smith ◽  
William J R Daily ◽  
Grant Fletcher ◽  
H Belton P Meyer ◽  
Gordon Taylor
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Newborn Infants ◽  
Arterial Oxygenation

Synchronized mechanical ventilation for respiratory support in newborn infants

2016 ◽  
Author(s):  
Anne Greenough ◽  
Vadivelam Murthy ◽  
Anthony D Milner ◽  
Thomas E Rossor ◽  
Adesh Sundaresan
Keyword(s):  
Mechanical Ventilation ◽  
Newborn Infants ◽  
Respiratory Support

Kangaroo (Skin-to-Skin) Care with a Preterm Infant Before, During, and After Mechanical Ventilation

2003 ◽  
Vol 22 (6) ◽  
pp. 33-38 ◽  
Author(s):  
Joan Swinth ◽  
Gene Cranston Anderson ◽  
Anthony Hadeed
Keyword(s):  
Mechanical Ventilation ◽  
Data Collection ◽  
Respiratory Distress ◽  
Preterm Infant ◽  
Maternal Stress ◽  
Supplemental Oxygen ◽  
Skin Care ◽  
Kangaroo Care ◽  
Skin To Skin

Using kangaroo care (KC) with unstable and/or ventilated infants remains controversial. In this article, potential advantages for ventilated infants and their mothers are discussed. The 33-week-gestation infant in this case study presented with mild respiratory distress at birth, requiring supplemental oxygen at hour 2. With no improvement by hour 18, KC was also begun, first for 1.25 hours and then, 2 hours later, for 3.5 hours. The infant was intubated at hour 45 for increasing respiratory distress, and KC resumed 24 hours later for 1 hour and 3 hours after that for an additional 3 hours. Extubation occurred at hour 90. Kangaroo care resumed 2 hours later for periods of 1.5, 1.5, and 1 hour over the next 8 hours, 2.5 hours more later that day (day 5, the last day of data collection). Thereafter, KC was done intermittently until discharge on day 9. Total KC times for pre-vent, vent, and immediate post-vent periods were 4.75, 4, and 6.5 hours, respectively. The data from this study suggest that KC may assist in, rather than retard, recovery from respiratory distress. KC may also foster maternal relaxation and minimize maternal stress.

scholarly journals Transient tachypnoea of the newborn (TTN) requiring mechanical ventilation - case report & review of literature

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 23-24
Author(s):  
ASM Iqbal ◽  
LN Begum
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Respiratory Distress ◽  
Newborn Infants ◽  
Review Of Literature ◽  
Limited Disease ◽  
Preterm Baby ◽  
Oxygen Supplement

Transient tachypnea of the newborn (TTN) is usually a benign and self-limited disease of the newborns and the prognosis is generally excellent. It is believed to be resulting from incomplete resorption of fluid from the lungs of the newborn. Infants present with respiratory distress, requiring oxygen supplement for 2-3 days. However some infants with severe symptoms and hypoxaemia may need prolonged oxygen supplement and sometimes mechanical ventilation. Here we present a borderline preterm baby with TTN, who required mechanical ventilation.DOI: 10.3329/pulse.v3i1.6549Pulse Vol.3(1) July 2009 p23-24

scholarly journals Persistent Ductus Arteriosus in Critically Ill Preterm Infants

2016 ◽  
Vol 2 (4) ◽  
pp. 175-184 ◽  
Author(s):  
Maria Livia Ognean ◽  
Oana Boantă ◽  
Simona Kovacs ◽  
Corina Zgârcea ◽  
Raluca Dumitra ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Ductus Arteriosus ◽  
Respiratory Support ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Group 1

Abstract Introduction: Persistent ductus arteriosus (PDA) is found with increased incidence in preterm infants, significantly affecting neonatal morbidity and mortality rates. Aim: To evaluate the association between the presence of PDA and the severity of clinical condition at birth in critically ill preterm infants, with gestational ages (GA) ≤ 32 weeks and severe respiratory distress. Methods: All preterm infants with GA ≤ 32 weeks admitted to the neonatal intensive care unit (NICU) of the Clinical County Emergency Hospital, Sibiu between 1 January 2010 and 31 December 2015 were included in the study. These were categorized as Group 1 [Preterm infants with PDA; n=154] and Group 2 [Preterm infants without PDA; n=186]. Epidemiological and clinical data were collected in the National Registry for Respiratory Distress Syndrome for all children, and data related to prenatal period, clinical characteristics at birth i.e GA, weight, gender, Apgar scores, and clinical features such as resuscitation at birth, surfactant administration, need and duration of respiratory support, neonatal sepsis, complications associated with prematurity, and death, were analyzed. Results: Group 1 infants had significantly lower GA and birth weights, were more often out born (p=0.049, HR 1.69), and had significantly lower Apgar scores at 1 and 10 minutes (p=0.022, p=0.000). They presented a significantly higher need for surfactant administration (42.9% vs 24.7%, p<0.0001) and respiratory support (96.8% vs 90.3%, HR 3.19, p=0.019 for need of CPAP and 22.1% vs 10.8%, HR 2.35, p=0.004 for mechanical ventilation). Duration of respiratory support was also significantly higher in the Group 1 (7.6%±7.5 vs. 5.1±3.8 days, p<0.0001 for CPAP and 20.1±22.5 vs. 12.0±15.7 days, p<0.0001 for mechanical ventilation). Conclusion: In very preterm infants, PDA may be associated with a critical clinical condition leading to serious complications. The presence of PDA after the seventh day of life was associated with an increased need for respiratory support, both CPAP and mechanical ventilation, increased severity of the respiratory distress syndrome, requiring a longer duration of respiratory support, and increased the hospitalization length. In very preterm infants, PDA presence was also associated with a higher rate of severe complications and death, indicating the need for a careful and proper management of these critical cases in neonatal intensive care units.

scholarly journals Respiratory Care in Children with COVID-19

2021 ◽  
Author(s):  
Shalu Gupta ◽  
Suresh K. Angurana ◽  
Virendra Kumar
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Health Care Providers ◽  
Respiratory System ◽  
Oxygen Delivery ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Critically Ill Children ◽  
Care Providers ◽  
Novel Coronavirus

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is causing significant morbidity and mortality worldwide. The common presentations in children include involvement of respiratory system leading to pneumonia and acute respiratory distress syndrome, as well as multiorgan dysfunction syndrome and multisystem inflammatory syndrome in children (MIS-C). Pediatric COVID-19 is a milder disease as compared with the adults. Also, there is rise in MIS-C cases which is a hyperinflammatory condition temporally associated with SARS-CoV-2. Since respiratory system is predominantly involved, few of these critically ill children often require respiratory support which can range from simple oxygen delivery devices, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical ventilation, and extracorporeal membrane oxygenation (ECMO). Most of the oxygen delivery devices and respiratory interventions generate aerosols and pose risk of transmission of virus to health care providers (HCPs). The use of HFNC and NIV should be limited to children with mild respiratory distress preferably in negative pressure rooms and with adequate personnel protective equipments (PPEs). However, there should be low thresholds for intubation and invasive mechanical ventilation in the event of clinical deterioration while on any respiratory support. The principle of providing respiratory support requires special droplet and air-borne precautions to limit exposure or transmission of virus to HCPs and at the same time ensuring safety of the patient.

Neonatal lung ultrasonography to evaluate need for surfactant or mechanical ventilation: a systematic review and meta-analysis

2019 ◽  
Vol 105 (2) ◽  
pp. 164-171 ◽  
Author(s):  
Abdul Razak ◽  
Maher Faden
Keyword(s):  
Mechanical Ventilation ◽  
Diagnostic Accuracy ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Late Preterm ◽  
Lung Ultrasonography ◽  
Term Infants ◽  
Surfactant Treatment ◽  
Increased Risk

ContextLung ultrasonography (LUS) is increasingly used to identify various neonatal respiratory disorders. There is emerging evidence that it can identify infants with significant lung disease who need surfactant treatment or mechanical ventilation.ObjectiveTo systematically review the accuracy of LUS in determining the need for surfactant treatment or mechanical ventilation in infants with respiratory distress treated with nasal continuous positive airway pressure (NCPAP).MethodsDatabase search include EMBASE, Medline, CINAHL and Cochrane central from inception until 17 October 2018. Included is diagnostic accuracy studies reporting LUS evaluating surfactant therapy/mechanical ventilation. Two authors extracted data independently and assessed quality. Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to determine the methodological quality.ResultsSix studies involving 485 infants included in the review. Three studies used LUS score, two used type 1 lung profile, and one used high-risk LUS to evaluate the outcome. The pooled sensitivity and specificity at LUS score cut-off >5–6 was 88% (95% CI 80% to 93%) and 82% (95% CI 74% to 89%), respectively. Infants with LUS score >5–6 were at significantly increased risk of surfactant treatment compared with infants with LUS score <5–6 (relative risk=7.51; 95% CI 4.16 to 13.58; two studies; participants=189; I2=0%). The diagnostic accuracy of type 1 lung profile was better in younger preterm infants (sensitivity 88.9%, specificity 100%) compared with late preterm and term infants (sensitivity 100%, specificity 28%).ConclusionsLUS, particularly LUS score, can be used accurately to determine the need for surfactant replacement treatment or mechanical ventilation in infants with respiratory distress treated with NCPAP support. The accuracy is better in younger preterm infants compared with late preterm and term infants.PROSPERO registration numberCRD42018115135.

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