scholarly journals Use of early nasal continuous positive airway pressure in preterm neonates with hyaline membrane disease (neonatal respiratory distress syndrome)

2021 ◽  
Vol 8 (3) ◽  
pp. 488
Author(s):  
R. D. M. Suresh Reddy ◽  
Seshagiri Koripadu ◽  
Harischandra Venkata Yanamandala
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Success Rate ◽  
Gestational Age ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Hyaline Membrane Disease ◽  
Nasal Cpap ◽  
Antenatal Steroids ◽  
Hyaline Membrane

Background: In developing countries like ours, there is high burden of prematurity and sub-optimal use of antenatal steroid administration resulting infrequent hyaline membrane disease (HMD).Methods: A total 50 cases of clinically diagnosed HMD with gestational age between 28-34 weeks admitted to neonatal intensive care unit (ICU). 50 babies were treated with early nasal continuous positive airway pressure (CPAP) (within 6 hours of onset of respiratory distress).Results: Incidence of prematurity was 12.42%. Incidence of HMD observed between gestational ages of 28-34 weeks is 3.2%. Out of total 50 babies who were managed with early nasal CPAP, it proved effective in 40 babies (80%), remaining 10 babies (20%) had to be intubated and required ventilation. Out of 10 babies who required ventilation 90% of the babies were less than 32 weeks gestation age; remaining 10% were between 33-34 weeks. Analysis of these results showed that outcome is better with increased gestational age (p<0.005). Out of 10 babies who failed 80% were <1500 g and remaining 20% above 1500 g. We found significant improvement (p<0.005) in SA score after application of nasal CPAP. Babies on CPAP had significant improvement in oxygenation (p<0.05). A success rate of 93.1% observed in moderate grade HMD (p<0.005). Out of 10 babies who failed on nasal CPAP, 80% of them had severe grade HMD and 20% showed moderate HMD. A success rate of 92.86% was found in babies of mothers who had received antenatal steroids and 63.63% of babies whose mothers had not received antenatal steroids improved with early nasal CPAP (p<0.05).Conclusions: Nasal CPAP is found to be effective in babies of mothers who had received antenatal steroids. Nasal CPAP is safe, inexpensive and effective means of respiratory support in HMD. Use of early nasal CPAP which is simple, non-invasive, has low capital outlay and does not require expertise, is the option for us where most places cannot provide invasive ventilation.

scholarly journals Nasal high-frequency percussive ventilation versus nasal continuous positive airway pressure in term and preterm neonates exhibiting respiratory distress: a randomized controlled trial (TONIPEP; NCT 02030691)

2020 ◽  
Author(s):  
Renesme Laurent ◽  
Dumas de la Roque Eric ◽  
Germain Christine ◽  
Chevrier Agnès ◽  
Rebola Muriel ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Gestational Age ◽  
High Frequency ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
List Type ◽  
Ventilation Mode ◽  
Nasal Cpap ◽  
The Mean

AbstractObjectiveTo determine whether the use of nasal, high-frequency percussive ventilation (nHFPV) to manage neonatal respiratory distress decreases the regional cerebral oxygen saturation (rScO2) below that afforded by nasal continuous positive airway pressure (nCPAP).DesignMonocentric, prospective, randomized, monocentric, open-label, non-inferiority crossover trial.PatientsNewborns of gestational age (GA) ≥ 33 weeks exhibiting persistent respiratory distress after 10 min of life (Silverman score ≥ 4).InterventionnHFPV and nCPAP, in succession and in random order.Main outcome measureMean rScO2, as revealed by near-infrared spectroscopy (NIRS) performed over the last 5 min of each ventilation mode. To show that nHFPV was not inferior to nCPAP, our a priori calculations required that the lower boundary of the bilateral 95% confidence interval (CI) of the difference between the mean rScO2 values of each ventilation mode should exceed –5.ResultsForty-nine newborns were randomized and 46 were analyzed. The mean (± standard deviation [SD]) GA and birth weight were 36.4 ± 1.9 weeks and 2,718 ± 497 g. The diagnosis was transient tachypnea in 65% of cases and respiratory distress syndrome in 35%. The mean rScO2 difference during the last 5 min of each ventilation mode (nHFPV minus nCPAP) was – 0.7 ± 5.4% (95% CI –2.25; 0.95). Neither a period effect nor a period-treatment interaction was evident. The mean transcutaneous carbon dioxide values (n = 26) for nCPAP and nHFPV were 7.1 ± 4.8 and 7.9 ± 5.1 kPa, respectively. No harmful or unintentional effect was observed.ConclusionIn our study on newborns of GA ≥ 33 weeks treated for respiratory distress, cerebral oxygenation via nHFPV was not inferior to nCPAP.What is already known on the topicNon-invasive high-frequency ventilation is feasible in preterm newborns and seems to improve ventilation compared to nasal CPAP.We previously showed that nasal high-frequency percussive ventilation (nHFPV) was more efficient that nCPAP for respiratory distress management in newborns of gestational age (GA) ≥ 35 weeks.The impact of mechanical ventilation, especially high-frequency modes, on cerebral blood flow in neonates is of concern.What this study addsnHFPV was well-tolerated and non-inferior to nasal CPAP as measured by rScO2 levels when used to manage respiratory distress at birth in newborns of GA ≥ 33 weeks.

ARTIFICIAL VENTILATION IN HYALINE MEMBRANE DISEASE: THE USE OF POSITIVE END-EXPIRATORY PRESSURE AND CONTINUOUS POSITIVE AIRWAY PRESSURE

PEDIATRICS ◽  
1973 ◽  
Vol 51 (4) ◽  
pp. 629-640
Author(s):  
Niloufer Cumarasamy ◽  
Rosmarie Nüssli ◽  
Dieter Vischer ◽  
Peter H. Dangel ◽  
Gabriel V. Duc
Keyword(s):  
Mechanical Ventilation ◽  
Survival Rate ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Artificial Ventilation ◽  
Controlled Trial ◽  
Hyaline Membrane Disease ◽  
Positive End Expiratory Pressure ◽  
Hyaline Membrane

During the years 1969, 1970, and 1971, 120 infants with hyaline membrane disease were studied, of whom 71 were treated with artificial ventilation. Among other changes in 1971, positive end-expiratory pressure was applied during mechanical ventilation and continuous positive airway pressure maintained during the weaning period. The survival rate of the ventilated babies increased from 23% in the preceding two years to 70% in 1971. As this study is not a controlled trial, the observed increase in survival cannot be ascribed to the application of increased airway pressure alone. The data presented, though necessarily inconclusive, may be useful for continuing comparisons with other pediatric centers.

Thoracic Transillumination: Aid in the Diagnosis and Treatment of Pneumopericardium

PEDIATRICS ◽  
1979 ◽  
Vol 64 (6) ◽  
pp. 958-960 ◽  
Author(s):  
Eresvita E. Cabatu ◽  
Edwin G. Brown
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Hyaline Membrane Disease ◽  
Pericardial Tamponade ◽  
Review Of The Literature ◽  
Air Leak ◽  
Hyaline Membrane ◽  
Life Threatening

A frequent complication of continuous positive airway pressure and mechanical ventilation used to treat neonates who have hyaline membrane disease and other forms of respiratory distress is an air leak from alveolar rupture. Pneumothorax and pneumomediastinum are common. Pneumopericardium does not occur often, but it can be life-threatening if it produces acute cardiac tamponade. In a review of the literature, Brans and associates1 found that pneumopericardium in neonates was treated by pericardiocentesis in one half of the published cases; 79% of them survived or they ultimately died of complications unrelated to pericardial tamponade. However, only 32% of the infants treated conservatively survived.

Continuous Positive Airway Pressure

PEDIATRICS ◽  
1972 ◽  
Vol 49 (3) ◽  
pp. 468-469
Author(s):  
Peter A. M. Auld ◽  
Alfred N. Krauss ◽  
David B. Klain
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Negative Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Clinical Course ◽  
Lower Extremities ◽  
Hyaline Membrane Disease ◽  
Positive Pressure ◽  
Hyaline Membrane ◽  
Intermittent Positive Pressure Breathing

The recent enthusiastic report of the use of continuous positive airway pressure (CPAP) prompts us to report our own experience with this method of therapy in infants with severe hyaline membrane disease. In 1968, four severely affected infants with hyaline membrane disease were treated with CPAP. The therapy was undertaken in infants whose clinical course was deteriorating under intermittent positive pressure breathing. The CPAP was applied by a negative pressure chamber that enclosed a child's chest, abdomen, and lower extremities.

scholarly journals Predictor Factors of Continuous Positive Airway Pressure Failure in Preterm Infants with Respiratory Distress

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110074
Author(s):  
Winda Intan Permatahati ◽  
Amalia Setyati ◽  
Ekawaty Lutfia Haksari
Keyword(s):  
Birth Weight ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Multivariate Logistic Regression Analysis ◽  
Mortality And Morbidity ◽  
Nasal Cpap ◽  
Cpap Failure

Respiratory distress contributes significantly to mortality, and morbidity in preterm infants. The incidence of nasal continuous positive airway pressure (CPAP) failure is remarkably high. There are limited data available regarding nasal CPAP failure in Indonesia, and this study is expected to be a reference in taking preventive measures to reduce mortality and morbidity in preterm infants. To determine predictive factors of nasal CPAP failure in preterm infants with respiratory distress. A retrospective cohort study was conducted in preterm infants with respiratory distress at the Neonatology ward of Dr. Sardjito Hospital during January 2017-July 2019. Chi-square or Fisher’s exact tests, followed by multivariate logistic regression analysis with backward method, was used to identify factors contributing to nasal CPAP failure. A total of 150 infants were included in this study. Fifty-three (37.8%) infants had nasal CPAP failure. Bivariate analysis showed birth weight <1000 g, singleton, APGAR score 4-7, premature rupture of membrane (PROM), Downes score, and initiation of fractional concentration of inspired (FiO2) requirement were all risk factors of nasal CPAP failure. However, only birth weight <1000 g ( P = .022; OR 2.69; CI 95% 1.34-5.44), initial Downes score ( P = .035; OR 2.68; CI 95% 3.10-24.11), and initiation of FiO2 requirement ≥30% ( P = .0001; OR 3.03; CI 95% 2.04-4.50) were significant predictors for nasal CPAP failure by multivariate analysis. Birth weight <1000 g, singleton, initial Downes score, and initiation of FiO2 requirement >30% were significant predictors of nasal CPAP failure in preterm infants with respiratory distress.

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