A Randomized Controlled Trial of Two Nasal Continuous Positive Airway Pressure Levels after Extubation in Preterm Infants
89
Citation
17
Reference
10
Related Paper
Citation Trend
Keywords:
Bronchopulmonary Dysplasia
Positive pressure
Ventilator-induced lung injury is a recognized risk factor for bronchopulmonary dysplasia. To determine whether primary continuous positive airway pressure (CPAP), defined as CPAP without previous endotracheal intubation for any indication, can reduce the need for intubation and mechanical ventilation in infants born at ≤32 weeks' gestational age. The literature was reviewed using the methodology for systematic reviews for the Consensus on Resuscitation Science adapted from the American Heart Association's International Liaison Committee on Resuscitation. Fourteen studies were reviewed. Eleven studies provided varying degrees of supportive evidence (level of evidence 3 to 4) that the use of primary CPAP can reduce the need for intubation and mechanical ventilation. The use of CPAP as a primary intervention and mode of respiratory support is an option for infants ≤32 weeks' gestation, but avoidance of intubation and mechanical ventilation is more likely in mature infants >27 weeks' gestation.
Bronchopulmonary Dysplasia
Neonatal Resuscitation
Cite
Citations (4)
Objective The mode of ventilation that is implicated in pneumothorax is the one at the time of its diagnosis. Although there is evidence that air leak starts many hours before it is clinically evident, there are no prior studies that have investigated the association of pneumothorax with the mode of ventilation few hours before rather than at the time of its diagnosis. Study Design A retrospective case–control study was conducted in the neonatal intensive care unit (NICU) between 2006 and 2016 where cases of neonates with pneumothorax were compared with gestational age-matched control neonates without pneumothorax. Respiratory support associated with pneumothorax was classified as the mode of ventilation 6 hours before the clinical diagnosis of pneumothorax. We investigated the factors that were different between cases and controls, and between cases of pneumothorax on bubble continuous positive airway pressure (bCPAP) and invasive mechanical ventilation (IMV). Result Of the 8,029 neonates admitted in the NICU during the study period, 223 (2.8%) developed pneumothorax. Among these, 127 occurred among 2,980 (4.3%) neonates on bCPAP, 38 among 809 (4.7%) neonates on IMV, and the remaining 58 among 4,240 (1.3%) neonates on room air. Those with pneumothorax were more likely to be male, have higher body weight, require respiratory support and surfactant administration, and have bronchopulmonary dysplasia (BPD). Among those who developed pneumothorax, there were differences in the gestational age, gender, and use of antenatal steroids between those who were on bCPAP as compared to those on IMV. IMV was associated with increased odds of pneumothorax as compared to those on bCPAP in a multivariable regression analysis. Cases on IMV had higher incidence of intraventricular hemorrhage, retinopathy of prematurity, BPD, and necrotizing enterocolitis, as well as longer length of stay as compared to those on bCPAP. Conclusion Neonates who require any respiratory support have higher incidence of pneumothorax. Among those on respiratory support, those on IMV had higher odds of pneumothorax and worse clinical outcomes as compared to those on bCPAP. Key Points
Bronchopulmonary Dysplasia
Cite
Citations (1)
Objective:To explored the high risk factor and preventive treatment countermeasures of premature with bronchopulmonary dysplasia.Methods:Retrospectived analyses the data of 110 premature cases in the department of paediatrics from October 2005 to November 2010.The cases: gestational age were less than or equal to 32 weeks,birth weight were less than or equal to 1500 grams,survival time greater than 28 days.75 cases need the treatment of mechanical ventilation.In the 75cases,14 cases were diagnosed as bronchopulmonary dysplasia(group BPD),the rest of 61cases as group NO-BPD.Comparative analyzed the gestational age,birth weight,use corticosteroids before birth,use pulmonary surfactant after birth,suffocation history,premature rupture of membrane history,the time of mechanical ventilation,oxygen time,patent ductus arteriosus and frequently lung infection between the two groups.Results:The rates of bronchopulmonary dysplasia were 12.73%(14/110).The difference of use corticosteroids before birth,use pulmonary surfactant after birth and suffocation history between the two groups wasn't statistically significant(P0.05).There was statistically significant of the difference of premature rupture of membrane history patent ductus arteriosus and frequently lung infection between the two groups(P0.05).There was statistically significant of the difference of gestational age,birth weight,the time of mechanical ventilation and oxygen time between the two groups(P0.01).Conclusion:To avoid premature delivery and low birth weight infant,shorten the time of mechanical ventilation and oxygen inhalation,prevent and reduce frequently lung infection and actively early phase comprehensive treatment were the important factors to prevent premature bronchopulmonary dysplasia.
Bronchopulmonary Dysplasia
Ductus arteriosus
Cite
Citations (0)
Objective To investigate the risk factors of neonatal ventilator-associated pneumonia(VAP).Methods A retrospective analysis was made on the clinical data of 203 cases of neonatal in intensive care unit by mechanical ventilation,involving two groups: 94cases of VAP and 109 cases of Non-VAP.Two groups were compared in terms of gender,birth weight,gestational age,underlying diseases,the times of tracheal intubation,invasive procedures,duration of mechanical ventilation,changes in condition and duration of hospitalization.Results The less weight,the higher morbidity of VAP is.The average gestational age with VAP was 34.12±3.24 weeks and the average gestational age with Non-VAP was 36.23±3.12 weeks.The result in two groups were significant different(P0.05).The times of intubation and length of hospitalization in two groups were significantly different(P=0.006 and P=0.005).Conclusion The morbidity of VAP was closely related to internal factors,such as the neonatal gestational age and birth weight.On the other hand,the external factors,such as tracheal intubation and hospitalization,could significantly affect the morbidity of VAP.
Ventilator-associated Pneumonia
Cite
Citations (0)
Objective To explore the incidence rate and high-risk factors for bronchopulmonary dysplasia(BPD) in premature infants of mechanical ventilation.Methods From Jan 2008 to Dec 2009,196 very low birth weight infants with gestational age less than 32 weeks in our NICU were enrolled in the study.61 cases had the histories of mechanical ventilation.The clinical materials of 21 cases with BPD were compared to 41 cases without BPD in retrospective analysis.Results The total incidence of BPD in the very low birth weight infants with gestational age less than 32 weeks was 10.7%,and 34.4% in those infants with mechanical ventilation.The gestational age and birth weight of BPD group were lower than those without BPD,and the rates of premature rupture of fetal membrane and complicated neonatal respiratory distress syndrome (NRDS),postnatal infection,with long time intravenous nutrition in BPD group were higher than those without BPO control (P 0.05).Peak inspiratory pressure (PIP),the time of mechanical ventilation and oxygen administration were different significantly between two groups (P<0.05).NRDS,postnatal infection,the duration of ventilation,and hyperoxia were the risk factors for BPD,and the regression coefficient were 3.683,1.541,1.188 and 1.647.Conclusion Preventing premature,low birth weight,NRDS,shortening the duration of high peak inspiratory pressure and hyperoxia with mechanical ventilation and the use of the parenteral nutrition,managing the infection of the prenatal and postnatal are the key points of preventing BPD.
Key words:
Mechanical ventilation; Premature infant; Bronchopulmonary dysplasia; Risk factors
Bronchopulmonary Dysplasia
Hyperoxia
Peak inspiratory pressure
Cite
Citations (0)
To identify the risk factors for bronchopulmonary dysplasia (BPD) in neonates with respiratory distress syndrome (RDS).Data from 72 patients with RDS (birth weight 1607 +/- 277 g; gestational age 29.47 +/- 2.54 weeks) who were hospitalized for >28 days and who received mechanical ventilation treatment between January 2001 and August 2005 were studied retrospectively. A logistic regression analysis was used to identify the risk factors associated with the development of BPD.Of the 72 patients, 17 developed BPD (23.6%). Uniovariate analysis revealed that in addition to a gestational age of < or = 30 weeks and a birth weight below 1250 g, the times of mechanical ventilation treatment (> or = 2 times), concurrent pulmonary infection and pneumorrhagia, prolonged mechanical ventilation (> or = 5 days), and positive sputum bacterial cultures on 2 occasions were all associated with an increase in the incidence of BPD. Multivariate logistic analysis revealed that birth weight below 1250 g, prolonged mechanical ventilation (> or = 10 days),and positive sputum cultures on 3 or more occasions were independent risk factors for BPD (OR=6.614,14.997 and 39.752 respectively).The risk for BPD is multifactorial. Preventing small gestational age and low birth weight prematurity, decreasing the duration of mechanical ventilation and treatment of pulmonary infection are necessary to prevent BPD.
Bronchopulmonary Dysplasia
Cite
Citations (1)
[Objective]To analyze the high-risk factors of bronchopulmonary dysplasia among very low birth weight infant(VLBWI).[Methods]The cases of 69 VLBWI whose birth weight≤1 500 g,age≤36 weeks and survival time ≥28 days admitted to neonatal intensive care unit in our hospital in the last 6 years were analyzed retrospectively.Compared gestational age,birth weight,neonatal respiratory distress syndrome,mechanical ventilation time,24-48 h liquid intake after birth and repeated lung infection among 27 cases of BPD(BPD group)and 42 patients with non-BPD(control group)VLBWI.[Results]Univariate analysis showed that young gestational age,low birth weight,mechanical ventilation≥10d,and repeated lung infections were independent risk factors for BPD incidence(P﹤0.05);Multivariate Logistic regression showed that gestational age was the high risk factor for VLBWI suffering from BPD(OR = 0.656,P = 0.031).[Conclusion]Avoiding prolonged mechanical ventilation of the very low birth weight and/or premature birth infants and effectively controlling pulmonary infection are the keys for BPD prevention and treatment.
Bronchopulmonary Dysplasia
Univariate analysis
Cite
Citations (0)
Objective The objective of this study was to determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in very low-birth-weight (VLBW) infants managed successfully on continuous positive airway pressure (CPAP) versus mechanical ventilation on the first day of life (DOL). Study Design This is a retrospective analysis of the Alere neonatal database for infants born between January 2009 and December 2014, weighing ≤ 1,500 g. Baseline demographics, clinical characteristics, and outcomes were compared between the two groups. Multivariable regression analysis was performed to control the variables that differ in bivariate analysis. Results In this study, 4,629 infants (birth weight 1,034 ± 290 g, gestational age 28.1 ± 2.5 weeks) met the inclusion criteria. The successful use of early CPAP was associated with a significant reduction in BPD or death (p < 0.001), as well as days to room air, decreased oxygen use at discharge, lower risk for severe intraventricular hemorrhage, and patent ductus arteriosus requiring surgical ligation (p < 0.001 for all outcomes). Conclusion Successful use of early CPAP on the first DOL in VLBW infants is associated with a reduced risk of BPD or death.
Bronchopulmonary Dysplasia
Ductus arteriosus
Mean airway pressure
Cite
Citations (15)
Background
Bronchopulmonary dysplasia (BPD) is a major complication of prematurity, but the ability to predict which infants with a given birth weight or gestational age will experience this morbidity remains poor. We consider whether a physiologic marker of respiratory status between 4 and 10 days after birth, the PRSS (mean airway pressure × FiO2), can also serve as an early predictor of BPD.Methods
We studied infants <32 weeks gestational age requiring CPAP or ventilation who were enrolled in two multicenter trials, the NO CLD trial (infants randomized to either postnatal nitric oxide or placebo at 20 centers) and the North American Thyrotropin-Releasing Hormone study (TRH) (Ballard RA, NEJM, 1998). Peak respiratory severity score (PRSS) was collected from bedside flowsheet data. Logistic regression models were developed to determine the association of the PRSS between 4 and 10 days after birth and the development of BPD, defined as an oxygen requirement at 36 weeks postmenstrual age. Birth weight and gestational age were included in separate models to control for baseline risk of BPD.Results
332 patients from the NO CLD trial and 194 from the TRH trial required CPAP or mechanical ventilation between days 4 and 10 after birth. The mean birth weight was 748 6 124 g and gestational age was 25 6 2.5 weeks. 308 (59%) developed BPD. Logistic regression models including birth weight and PRSS showed that the PRSS between 4 and 10 days was significantly associated with BPD using thresholds of both 3.5 [OR 2.0, 95% CI 1.4-2.8] and 4.0 [OR 2.1, 95% CI 1.5-3.0]. Although birth weight alone was significantly associated with BPD (p=0.03), when PRSS was added to the model, birth weight was no longer significant. When gestational age was substituted for birth weight in the predictive models, PRSS remained significantly associated with the development of BPD. Both PRSS thresholds remained significantly associated with BPD when each trial was analyzed separately.Conclusions
The PRSS that a ventilated infant reaches between 4 and 10 days after birth is a significant risk factor for occurrence of BPD. This finding emphasizes the role of early postnatal lung disease in the development of BPD. PRSS may be a useful clinical and research tool to identify infants at increased risk for BPD.Bronchopulmonary Dysplasia
Mean airway pressure
Cite
Citations (1)
The aim of this study was to evaluate the inspiration fraction of oxygen (FiO2) trend as an indicator of timing to suspend nasal continuous positive airway pressure (N-CPAP) and shift the babies to mechanical ventilation, in order to reduce the incidence of pneumothorax, comparing a similar population admitted in our division during the previous year.Seventy-five newborns (mean gestational age 33.5 weeks, mean birth weight 2,072 g) admitted during 2003 in our Neonatal Intensive Care Unit, treated with Infant Flow System Nasal-CPAP, were included. Patients with more than 40% increase of the starting FiO2 in the first 24 h of treatment, were intubated and shift on mechanical ventilation. Seventy-seven infants, admitted during the previous year, with similar characteristics (mean gestational age 33.7 weeks, mean birth weight 2,047 g) were considered as control.Fifty-six neonates improved, 19 worsened and required mechanical ventilation. One of these developed pneumothorax (1.3%). Of the 77 infants admitted during the previous year, 26 worsened and were mechanically ventilated, and 8 developed pneumothorax (10.3%). The difference of incidence of pneumothorax was significant (P =0.0337).An increase of FiO2 more than 40% of the initial value during the first 24 h of N-CPAP may be considered a useful marker to identify infants at high risk of pneumothorax.
Mean airway pressure
Positive pressure
Cite
Citations (2)