👉A Review on Non-invasive Respiratory Support for Management of Respiratory Distress in Extremely Preterm Infants
📌Majority of extremely preterm infants require positive pressure ventilatory support at the time of delivery or during the transitional period. Most of these infants present with respiratory distress (RD) and continue to require significant respiratory support in the neonatal intensive care unit (NICU). Bronchopulmonary dysplasia (BPD) remains as one of the major morbidities among survivors of the extremely preterm infants. BPD is associated with long-term adverse pulmonary and neurological outcomes. Invasive mechanical ventilation (IMV) and supplemental oxygen are two major risk factors for the development of BPD. Non-invasive ventilation (NIV) has been shown to decrease the need for IMV and reduce the risk of BPD when compared to IMV. This article reviews respiratory management with current NIV support strategies in extremely preterm infants both in delivery room as well as in the NICU and discusses the evidence to support commonly used NIV modes including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), bi-level positive pressure (BI-PAP), high flow nasal cannula (HFNC), and newer NIV strategies currently being studied including, nasal high frequency ventilation (NHFV) and non-invasive neutrally adjusted ventilatory assist (NIV-NAVA). Randomized, clinical trials have shown that early NIPPV is superior to NCPAP to decrease the need for intubation and IMV in preterm infants with RD. It is also important to understand that selection of the device used to deliver NIPPV has a significant impact on its success. Ventilator generated NIPPV results in significantly lower rates of extubation failures when compared to Bi-PAP. Future studies should address synchronized NIPPV including NIV-NAVA and early rescue use of NHFV in the respiratory management of extremely preterm infants.
🔗https://www.frontiersin.org/articles/10.3389/fped.2020.00270/full
#respiration #cpap #frontiers #respiratoty #rds
📌Majority of extremely preterm infants require positive pressure ventilatory support at the time of delivery or during the transitional period. Most of these infants present with respiratory distress (RD) and continue to require significant respiratory support in the neonatal intensive care unit (NICU). Bronchopulmonary dysplasia (BPD) remains as one of the major morbidities among survivors of the extremely preterm infants. BPD is associated with long-term adverse pulmonary and neurological outcomes. Invasive mechanical ventilation (IMV) and supplemental oxygen are two major risk factors for the development of BPD. Non-invasive ventilation (NIV) has been shown to decrease the need for IMV and reduce the risk of BPD when compared to IMV. This article reviews respiratory management with current NIV support strategies in extremely preterm infants both in delivery room as well as in the NICU and discusses the evidence to support commonly used NIV modes including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), bi-level positive pressure (BI-PAP), high flow nasal cannula (HFNC), and newer NIV strategies currently being studied including, nasal high frequency ventilation (NHFV) and non-invasive neutrally adjusted ventilatory assist (NIV-NAVA). Randomized, clinical trials have shown that early NIPPV is superior to NCPAP to decrease the need for intubation and IMV in preterm infants with RD. It is also important to understand that selection of the device used to deliver NIPPV has a significant impact on its success. Ventilator generated NIPPV results in significantly lower rates of extubation failures when compared to Bi-PAP. Future studies should address synchronized NIPPV including NIV-NAVA and early rescue use of NHFV in the respiratory management of extremely preterm infants.
🔗https://www.frontiersin.org/articles/10.3389/fped.2020.00270/full
#respiration #cpap #frontiers #respiratoty #rds
👉Biomarkers and Disease Severity in Children With Community-Acquired Pneumonia
📌WBC count, ANC, CRP, and procalcitonin are generally not useful to discriminate nonsevere from severe disease in children with CAP, although CRP and procalcitonin may have some utility in predicting the most severe outcomes.
🔗https://pediatrics.aappublications.org/content/145/6/e20193728
#pneumonia #crp #pct #respiration #aap #pulmonology #infections #pediatrics
📌WBC count, ANC, CRP, and procalcitonin are generally not useful to discriminate nonsevere from severe disease in children with CAP, although CRP and procalcitonin may have some utility in predicting the most severe outcomes.
🔗https://pediatrics.aappublications.org/content/145/6/e20193728
#pneumonia #crp #pct #respiration #aap #pulmonology #infections #pediatrics
👉Nasal mask vs binasal prongs for nasal continuous positive airway pressure in preterm infants: A systematic review and meta‐analysis
📌Among premature infants, NCPAP provided with NM is more effective in preventing intubation and mechanical ventilation within 72 hours of initiating the support compared with NCPAP provided with BNP.
🔗https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.24878
#cpap #respiration #preterm #nicu #wiley
📌Among premature infants, NCPAP provided with NM is more effective in preventing intubation and mechanical ventilation within 72 hours of initiating the support compared with NCPAP provided with BNP.
🔗https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.24878
#cpap #respiration #preterm #nicu #wiley
👉A randomized controlled trial of restricted versus standard fluid management in late preterm and term infants with transient tachypnea of the newborn
📌This trial demonstrated the safety and effectiveness of restrictive fluid strategy in reducing CPAP duration in late preterm and term babies with TTNB. Late preterm babies, especially those not exposed to antenatal steroid were the most benefitted by this strategy.
🔗https://pubmed.ncbi.nlm.nih.gov/32444567/
#ttn #respiration #pulmonology #tachypnea
📌This trial demonstrated the safety and effectiveness of restrictive fluid strategy in reducing CPAP duration in late preterm and term babies with TTNB. Late preterm babies, especially those not exposed to antenatal steroid were the most benefitted by this strategy.
🔗https://pubmed.ncbi.nlm.nih.gov/32444567/
#ttn #respiration #pulmonology #tachypnea
👉Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study
📌Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.
🔗https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02129-2
#respiration #bld #preterm #bmj #ventilation
📌Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.
🔗https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02129-2
#respiration #bld #preterm #bmj #ventilation
👉Oxygenation Instability Assessed by SpO 2 Histograms during Supine vs. Prone Position in Very Low Birthweight Infants Receiving Non-invasive Respiratory Support
📌Prone position decreased #oxygenation instability and resulted in higher oxygenation among VLBW premature infants on non-invasive respiratory support. SpO2 histograms allow easy bedside assessment of oxygenation instability, and quantification of the time spent at different SpO2 ranges.
🔗https://doi.org/10.1016/j.jpeds.2020.06.066
#respiratory #respiration
📌Prone position decreased #oxygenation instability and resulted in higher oxygenation among VLBW premature infants on non-invasive respiratory support. SpO2 histograms allow easy bedside assessment of oxygenation instability, and quantification of the time spent at different SpO2 ranges.
🔗https://doi.org/10.1016/j.jpeds.2020.06.066
#respiratory #respiration
👉#Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial
📌Lung recruitment before surfactant (IN-REC-SURE) ~open lung #ventilation compared to #INSURE reduces need for mechanical ventilation without increasing harm (pneumo/IVH/mortality) in <28 w Prems.
🔗https://doi.org/10.1016/S2213-2600(20)30179-X
#respiratory #respiration
📌Lung recruitment before surfactant (IN-REC-SURE) ~open lung #ventilation compared to #INSURE reduces need for mechanical ventilation without increasing harm (pneumo/IVH/mortality) in <28 w Prems.
🔗https://doi.org/10.1016/S2213-2600(20)30179-X
#respiratory #respiration