scholarly journals The Effect of Initial Oxygen Exposure on Diaphragm Activity in Preterm Infants at Birth

2021 ◽  
Vol 9 ◽  
Author(s):  
Ruud W. van Leuteren ◽  
Anouk W. J. Scholten ◽  
Janneke Dekker ◽  
Tessa Martherus ◽  
Frans H. de Jongh ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preterm Infants ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Low Oxygen ◽  
Randomized Controlled ◽  
Oxygen Group ◽  
Breathing Effort ◽  
Diaphragm Activity

Background: The initial FiO2 that should be used for the stabilization of preterm infants in the delivery room (DR) is still a matter of debate as both hypoxia and hyperoxia should be prevented. A recent randomized controlled trial showed that preterm infants [gestational age (GA) < 30 weeks] stabilized with an initial high FiO2 (1.0) had a significantly higher breathing effort than infants stabilized with a low FiO2 (0.3). As the diaphragm is the main respiratory muscle in these infants, we aimed to describe the effects of the initial FiO2 on diaphragm activity.Methods: In a subgroup of infants from the original bi-center randomized controlled trial diaphragm activity was measured with transcutaneous electromyography of the diaphragm (dEMG), using three skin electrodes that were placed directly after birth. Diaphragm activity was compared in the first 5 min after birth. From the dEMG respiratory waveform several outcome measures were determined for comparison of the groups: average peak- and tonic inspiratory activity (dEMGpeak and dEMGton, respectively), inspiratory amplitude (dEMGamp), area under the curve (dEMGAUC) and the respiratory rate (RR).Results: Thirty-one infants were included in this subgroup, of which 29 could be analyzed [n = 15 (median GA 28.4 weeks) and n = 14 (median GA 27.9 weeks) for the 100 and 30% oxygen group, respectively]. Tonic diaphragm activity was significantly higher in the high FiO2-group (4.3 ± 2.1 μV vs. 2.9 ± 1.1 μV; p = 0.047). The other dEMG-parameters (dEMGpeak, dEMGamp, dEMGAUC) showed consistently higher values in the high FiO2 group, but did not reach statistical significance. Average RR showed similar values in both groups (34 ± 9 vs. 32 ± 10 breaths/min for the high and low oxygen group, respectively).Conclusion: Preterm infants stabilized with an initial high FiO2 showed significantly more tonic diaphragm activity and an overall trend toward a higher level of diaphragm activity than those stabilized with an initial low FiO2. These results confirm that a high initial FiO2 after birth stimulates breathing effort, which can be objectified with dEMG.

scholarly journals Caffeine to improve breathing effort of preterm infants at birth: a randomized controlled trial

2017 ◽  
Vol 82 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Janneke Dekker ◽  
Stuart B Hooper ◽  
Jeroen J van Vonderen ◽  
Ruben S G M Witlox ◽  
Enrico Lopriore ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preterm Infants ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Breathing Effort

scholarly journals The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial

2019 ◽  
Vol 7 ◽  
Author(s):  
Janneke Dekker ◽  
Tessa Martherus ◽  
Enrico Lopriore ◽  
Martin Giera ◽  
Erin V. McGillick ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preterm Infants ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Breathing Effort

scholarly journals Patent ductus arteriosus, systemic NT-proBNP concentrations and development of bronchopulmonary dysplasia in very preterm infants: retrospective data analysis from a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Solomiia Potsiurko ◽  
Dmytro Dobryanskyy ◽  
Lesya Sekretar
Keyword(s):  
Randomized Controlled Trial ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Roc Curve ◽  
Controlled Trial ◽  
Ductus Arteriosus ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Randomized Controlled ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus (PDA) is a common complication in very preterm infants. It is known that there is an association between PDA and development of bronchopulmonary dysplasia (BPD) or death before the postmenstrual age (PMA) of 36 weeks, but this association remains one of the most controversial aspects of the problem. The study aimed to evaluate the relationship between PDA, serum NT-proBNP levels at 2–3 and 8–9 days of life, and BPD/death in very preterm infants. Methods Data of 52 preterm infants with a gestational age < 32 weeks, chronological age < 72 h, and PDA diameter > 1.5 mm, enrolled in a randomized controlled trial, were used for the retrospective analysis. All patients underwent daily echocardiographic and two serum NT-proBNP measurements within the first 10 days after birth. Two groups of infants were formed retrospectively at PMA of 36 weeks depending on the outcome, BPD (n = 18)/death (n = 7) or survival without BPD (n = 27). Receiver operator characteristic (ROC) curve was used to evaluate the predictive performance of serum NT-proBNP levels for BPD/death occurrence. Results The percentage of infants who received pharmacological treatment for PDA did not differ between the groups. Based on the area under the ROC curve, serum NT-proBNP levels on the 2–3 day of life (AUC = 0.71; 95% confidence interval (CI): 0.56–0.9; p = 0.014)) and on the 8–9 day of life (AUC = 0.76; 95% CI: 0.6–0.9; p = 0.002) could reliably predict BPD/death in very preterm infants who had PDA diameter > 1.5 mm in the first 72 h of life. Hemodynamically significant PDA (hsPDA) was significantly more often detected in newborns with BPD/death, however, treatment of infants with hsPDA did not reduce the incidence of BPD/death. Conclusions In very preterm infants with PDA > 1.5 mm at the age of 24–48 h, serum NT-proBNP concentration could reliably predict the development of BPD or death, regardless of the persistence of PDA, with the highest diagnostic value at 8–9 days. Trial registration This study is registered in ClinicalTrials.gov - NCT03860428 on March 4, 2019.

scholarly journals Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098491
Author(s):  
Yan Li ◽  
Qiufen Wei ◽  
Dan Zhao ◽  
Yan Mo ◽  
Liping Yao ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preterm Infants ◽  
High Frequency ◽  
Controlled Trial ◽  
High Frequency Oscillatory Ventilation ◽  
Positive Pressure ◽  
Non Invasive ◽  
Randomized Controlled ◽  
Oscillatory Ventilation ◽  
High Frequency Oscillatory

Objective To investigate the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) in post-extubation preterm infants. Methods This was a randomized, controlled trial. A total of 149 preterm infants aged between 25 to 34 weeks’ gestational age with a birth weight of <1500 g who required invasive mechanical ventilation on admission were included. After extubation, they were randomized to the NHFOV group (n = 47), nasal intermittent positive pressure ventilation (NIPPV) group (n = 51), or nasal continuous positive airway pressure (NCPAP) group (n = 51). We compared the effectiveness and safety among these three groups. Results A total of 139 preterm infants finally completed the study. The reintubation rate was significantly lower in the NHFOV group than in the other groups. The duration of non-invasive ventilation and the length of hospital stay in the NHFOV and NIPPV groups were significantly shorter than those in the NCPAP group. The incidence of bronchopulmonary dysplasia in the NHFOV and NIPPV groups was significantly lower than that in the NCPAP group. The NHFOV group had significantly less nasal injury than the NCPAP group. Conclusion As post-extubation respiratory support in preterm infants, NHFOV has a lower reintubation rate compared with NCPAP and NIPPV, without increasing the rate of complications.

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