Initial respiratory management in preterm infants and bronchopulmonary dysplasia

Abstract

BACKGROUND:Ventilator injury has been implicated in the pathogenesis of bronchopulmonary dysplasia. Avoiding invasive ventilation could reduce lung injury, and early respiratory management may affect pulmonary outcomes.OBJECTIVE:To analyze the effect of initial respiratory support on survival without bronchopulmonary dysplasia at a gestational age of 36 weeks.DESIGN/METHODS:A prospective 3-year observational study. Preterm infants of <32 weeks gestational age were classified into 4 groups according to the support needed during the first 2 hours of life: room air, nasal continuous positive airway pressure, intubation/surfactant/extubation and prolonged mechanical ventilation (defined as needing mechanical ventilation for more than 2 hours).RESULTS:Of the 329 eligible patients, a total of 49% did not need intubation, and 68.4% did not require prolonged mechanical ventilation. At a gestational age of 26 weeks, there was a significant correlation between survival without bronchopulmonary dysplasia and initial respiratory support. Preterm infants requiring mechanical ventilation showed a higher risk of death and bronchopulmonary dysplasia. After controlling for gestational age, antenatal corticosteroid use, maternal preeclampsia and chorioamnionitis, the survival rate without bronchopulmonary dysplasia remained significantly lower in the mechanically ventilated group.CONCLUSIONS:In our population, the need for more than 2 hours of mechanical ventilation predicted the development of bronchopulmonary dysplasia in preterm infants with a gestational age >26 weeks (sensitivity = 89.5% and specificity = 67%). The need for prolonged mechanical ventilation could be an early marker for the development of bronchopulmonary dysplasia. This finding could help identify a target population with a high risk of chronic lung disease. Future research is needed to determine other strategies to prevent bronchopulmonary dysplasia in this high-risk group of patients.

Effects of daily kangaroo care on cardiorespiratory parameters in preterm infants

“…A few neonates, especially if not exposed to prenatal steroids or if exposed to chorioamnionitis, may even require continued endotracheal intubation and mechanical ventilation. [6,7] Although these interventions are life-saving, they can in turn lead to chronic lung disease [8] and subsequent adverse neurodevelopmental effects. [9–15] Safe and effective treatments are needed to prevent adverse cardiorespiratory events and to promote physiologic stability and positive developmental outcomes in preterm infants.…”

Impact of Changes in Perinatal Care on Neonatal Respiratory Outcome and Survival of Preterm Newborns: An Overview of 15 Years

“…BPD affects thousands of preterm infants each year [23] and its cause is multifactorial. The pathogenesis has been linked to genetic background, lung tissue immaturity, baro and volutrauma from mechanical ventilation, oxidant injury, and proinflammatory mediators [4, 24–26].…”

“…The use of antenatal corticosteroids, postnatal surfactant therapy, and modern intensive care has modified BPD into a less-severe disease that is characterized by arrested lung development, the new BPD. As ventilator-induced lung injury is a major contributing factor to BPD [23], early respiratory management of preterm infants affects respiratory outcome. …”

Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies

“…39 Practices such as use of a minimally invasive approach in the delivery suite and early administration of surfactant may help reduce the number of infants who undergo prolonged mechanical ventilation and its long-term complications. 5 However, having staff who are sufficiently trained in the use of any mode of mechanical ventilation is essential for successful implementation and optimal outcomes. 40 …”