2019 Year in Review: Neonatal Respiratory Support

Wheeler, Craig R; Smallwood, Craig D

doi:10.4187/respcare.07720

Cited by 13 publications

(20 citation statements)

References 90 publications

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“…Other parameters than humidity and flow rate (2 L/min), such as temperature, air composition and oxygen content, were not studied. Moreover, oxygen therapy via an oxygen cannula does not accurately represent the most invasive and non-invasive respiratory equipment used in a NICU (Wheeler & Smallwood, 2020).…”

Section: Respiratory Supportmentioning

confidence: 99%

Plasticizers in the neonatal intensive care unit: A review on exposure sources and health hazards

Panneel

Malarvannan

Jorens

et al. 2021

Critical Reviews in Environmental Science and Technology

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Plasticizers, used to increase the flexibility of plastic materials, can leach into the environment and the human body. Various adverse health effects are attributed to exposure to plasticizers, particularly phthalates. Premature newborns admitted to a neonatal intensive care unit (NICU) are exposed to many indwelling plastic devices containing plasticizers while in a developmentally vulnerable period. This is the first comprehensive review of its kind, providing an overview of DEHP and alternative plasticizers (APs), their sources and degree of exposure in the NICU, and the resulting health risks in (premature) infants. Despite the 2017 EU Medical Devices Regulation (2017/745), di-(2-ethylhexyl) phthalate (DEHP) is still a commonly present plasticizer in plastic medical devices in the NICU, with current labelling being insufficient to guarantee absence. Estimated NICU exposures remain elevated above the tolerable daily intake. Medical procedures leading to the highest exposure of phthalates and APs, are extracorporeal membrane oxygenation, blood transfusion, parenteral nutrition and respiratory support.As traditional matrices, such as blood and urine, are not always readily available in neonates, the accumulation of plasticizers in alternative matrices, such as hair and nails, provides an opportunity to study long-term accumulation of toxic chemicals. Impaired respiratory and neurodevelopment correlate with phthalate exposure at both biological and epidemiological levels in childhood, yet knowledge gaps about the effects in neonates prevail. Some APs provide interesting opportunities to reduce toxicity, but human data regarding health effects remain limited. Although toxicologists and regulators have addressed the problem for some time, awareness is lacking mainly among healthcare professionals.

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Section: Respiratory Supportmentioning

confidence: 99%

Plasticizers in the neonatal intensive care unit: A review on exposure sources and health hazards

Panneel

Malarvannan

Jorens

et al. 2021

Critical Reviews in Environmental Science and Technology

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“…Despite a recent shift from invasive forms to noninvasive ones, RS is still a prevalent procedure in VLBW neonates. 33 The work of breathing as a measure of energy expenditure may be as high as 6-fold in an infant with respiratory distress, a typical case in VLBW neonates, compared with normal infants. 26 Assuming that accelerating weight through increasing administered calories can compensate energy expenditure for neonates' work of breathing, the authors hypothesized that the duration of RS in the experimental group would be significantly lower than that of the control group (Hypothesis 2).…”

Section: Duration Of Respiratory Supportmentioning

confidence: 99%

The Effect of High Glucose Intake on Weight Gain in Very Low Birth Weight Neonates: A Randomized Controlled Trial

Choobdar

Mazouri

Firuzian

et al. 2021

Clin Pediatr (Phila)

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This study aims at evaluating the effect of high glucose intake as a component of total parenteral nutrition on birth weight (BW) regain in very low birth weight neonates. Ninety newborns with BW <1500 g were randomized to control or experimental groups. Both groups received the same total parenteral nutrition regimens except glucose intake provided by dextrose water (DW) serum: 7 to 15 g/kg/d (10% DW) in the former versus 8.75 to 18.75 g/kg/d (12.5% DW) in the latter. Body weight as the primary outcome was monitored until the BW was regained. Results revealed that neonates who received 12.5% DW regained BW significantly faster (10.98 ± 2.46 vs 13.24 ± 4.03 days, P = .024) and needed lesser duration of respiratory support (5.34 ± 2.11 vs 7.17 ± 3.19 days, P = .003). As the proposed intervention can reduce neonatal intensive care unit admission duration, it mitigates risks of health care−associated infections, while favorably affecting the health economy.

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“…The use of invasive mechanical ventilation (IMV) via an endotracheal tube, in addition to other interventions such as the use of exogenous surfactant 1 and antenatal steroids, 2 has contributed to improvement in neonatal survival. 3 However, the prolonged use of IMV may predispose infants to the development of various complications, including bronchopulmonary dysplasia. 4 , 5 Avoiding IMV is a goal in clinical care, 3 and different modes of non-invasive ventilation (NIV), such as high flow nasal cannula (HFNC), 6 nasal continuous positive airway pressure (NCPAP), 6 nasal intermittent positive pressure ventilation (NIPPV), 7 and its more advantageous form, synchronized nasal intermittent positive pressure ventilation (SNIPPV), 8 have been shown to decrease the rate of IMV.…”

Section: Introductionmentioning

confidence: 99%

“… 3 However, the prolonged use of IMV may predispose infants to the development of various complications, including bronchopulmonary dysplasia. 4 , 5 Avoiding IMV is a goal in clinical care, 3 and different modes of non-invasive ventilation (NIV), such as high flow nasal cannula (HFNC), 6 nasal continuous positive airway pressure (NCPAP), 6 nasal intermittent positive pressure ventilation (NIPPV), 7 and its more advantageous form, synchronized nasal intermittent positive pressure ventilation (SNIPPV), 8 have been shown to decrease the rate of IMV. For example, though not a feature explored in the current study, the use of SNIPPV has been demonstrated to have several benefits in preterm infants, including decreased work of breathing, 9 reduction in incidence of apnea of prematurity, 8 shorter duration of ventilation, 10 and reduction in death for very low birth weight infants.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Common Nasal Cannulas in Neonatal Noninvasive Ventilation (NIV) Using a Novel Neonatal Nasal Model

Borg¹,

Aviano²,

Ginani³

et al. 2022

MDER

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Purpose Non-invasive ventilation (NIV) may reduce intubation rates and be especially beneficial in the care of preterm infants, in addition to other care modalities. Currently, ventilators do not display the pressure at the nares but the pressure in the ventilator tubing system. There are several nasal cannulas available for use to deliver NIV. The purpose of this study was to compare the inspiratory pressure on the ventilator to the measured pressure delivered at the nares using three cannula brands (Manufacturer A, Fisher & Paykel; Manufacturer B, Neotech RAM; and Manufacturer C, Hudson RCI). Patients and Methods This bench study utilized a 3D printed nasal model, including nares in multiple sizes to accommodate all nasal prongs studied. The nasal adaptors were connected to neonatal test lungs, to simulate patient breathing. Multiple sizes of nasal cannulas from the three manufacturers were tested for inspiratory vs delivered pressure at the patient side of the cannula, using eight combinations of ventilator settings. Each nasal cannula was tested on six Puritan Bennett™ 980 ventilators. Results The measured delivered pressure at the nares was consistently lower than the clinician-set inspiratory pressure. Across all ventilator settings, 7 of the 11 cannulas delivered significantly less pressure at the nares compared to the inspiratory ventilator pressure (p < 0.01). For each cannula, as inspiratory pressure increased, the difference between delivered and inspiratory pressures also increased. The cannula from Manufacturer B consistently demonstrated the greatest differences between set inspiratory and delivered pressures for each ventilator setting. Conclusion This study demonstrated substantial differences between ventilator inspiratory pressure and measured delivered pressure, which may have clinical significance. Being unaware of the actual airway pressure delivered to the patient may lead to erroneous adjustments to the level of ventilator pressure, which may be especially consequential to those with delicate and developing respiratory systems.

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2019 Year in Review: Neonatal Respiratory Support

Cited by 13 publications

References 90 publications

Plasticizers in the neonatal intensive care unit: A review on exposure sources and health hazards

Plasticizers in the neonatal intensive care unit: A review on exposure sources and health hazards

The Effect of High Glucose Intake on Weight Gain in Very Low Birth Weight Neonates: A Randomized Controlled Trial

Evaluation of Common Nasal Cannulas in Neonatal Noninvasive Ventilation (NIV) Using a Novel Neonatal Nasal Model

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