Changes in Use of Respiratory Support for Preterm Infants in the US, 2008-2018

Hatch, L. Dupree; Clark, Reese H.; Carlo, Waldemar A.; Stark, Ann R.; Ely, E. Wesley; Patrick, Stephen W.

doi:10.1001/jamapediatrics.2021.1921

Cited by 35 publications

(47 citation statements)

References 32 publications

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“…Non-invasive Respiratory Support (NRS) is the most common respiratory support for infants 22-24 weeks and accounts for most days on any respiratory support during their hospital stay [65]. However, the available evidence related to NRS in this category of patients is limited.…”

Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

Respiratory support of infants born at 22–24 weeks of gestational age

Norman

Jónsson

Wallström

et al. 2022

Seminars in Fetal and Neonatal Medicine

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Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

Respiratory support of infants born at 22–24 weeks of gestational age

Norman

Jónsson

Wallström

et al. 2022

Seminars in Fetal and Neonatal Medicine

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“…Therefore, neonatologists avoid and minimize MV in preterm infants. The use of MV as an initial modality to mitigate respiratory failure in ELBW infants has substantially declined over the past decade [9]. However, MV is at times a life-saving intervention to support the structurally and functionally immature lungs.…”

Section: Introductionmentioning

confidence: 99%

Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies

Thekkeveedu

El-Saie

Prakash

et al. 2022

JCM

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Supportive care with mechanical ventilation continues to be an essential strategy for managing severe neonatal respiratory failure; however, it is well known to cause and accentuate neonatal lung injury. The pathogenesis of ventilator-induced lung injury (VILI) is multifactorial and complex, resulting predominantly from interactions between ventilator-related factors and patient-related factors. Importantly, VILI is a significant risk factor for developing bronchopulmonary dysplasia (BPD), the most common chronic respiratory morbidity of preterm infants that lacks specific therapies, causes life-long morbidities, and imposes psychosocial and economic burdens. Studies of older children and adults suggest that understanding how and why VILI occurs is essential to developing strategies for mitigating VILI and its consequences. This article reviews the preclinical and clinical evidence on the pathogenesis and pathophysiology of VILI in neonates. We also highlight the evidence behind various lung-protective strategies to guide clinicians in preventing and attenuating VILI and, by extension, BPD in neonates. Further, we provide a snapshot of future directions that may help minimize neonatal VILI.

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“…The introduction of animal-derived lung surfactant in the 1990s has dramatically improved survival of very premature infants [ 3 ], but the high costs of porcine and bovine lung surfactant production have led to a search for an advanced synthetic lung surfactant formulation based on SP-B and/or SP-C peptide analogs in a phospholipid mixture [ 4 ]. However, all these surfactant preparations require intratracheal administration, whereas respiratory support of premature infants has gradually shifted from invasive to noninvasive support, and especially to nasal continuous positive airway pressure (nCPAP) [ 5 , 6 ] to minimize lung injury and chronic lung disease. Although noninvasive respiratory support can be assisted with surfactant instillation via a thin tracheal catheter, i.e., the less invasive surfactant administration (LISA) approach [ 7 ], aerosol delivery of dry powder (DP) synthetic lung surfactant better fits into a noninvasive respiratory support approach and eases surfactant administration to premature infants, especially those treated in a low-resource setting.…”

Section: Introductionmentioning

confidence: 99%

Efficacy, dose–response, and aerosol delivery of dry powder synthetic lung surfactant treatment in surfactant-deficient rabbits and premature lambs

et al. 2022

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Background Dry powder (DP) synthetic lung surfactant may be an effective means of noninvasive delivery of surfactant therapy to premature infants supported with nasal continuous positive airway pressure (nCPAP) in low-resource settings. Methods Four experimental DP surfactant formulations consisting of 70% of phospholipids (DPPC:POPG 7:3), 3% Super Mini-B (SMB) or its sulfur-free derivate B-YL as SP-B peptide mimic, 25% of lactose or trehalose as excipient, and 2% of NaCl were formulated using spray drying. In vitro surface activity was confirmed with captive bubble surfactometry. Surfactant particle size was determined with a cascade impactor and inhaled dose was quantified using a spontaneously breathing premature lamb lung model supported with CPAP. In vivo surfactant efficacy was demonstrated in three studies. First, oxygenation and lung compliance were monitored after intratracheal instillation of resuspended DP surfactant in intubated, ventilated, lavaged, surfactant-deficient juvenile rabbits. In dose–response studies, ventilated, lavaged, surfactant-deficient rabbits received 30, 60, 120 or 240 mg/kg of DP B-YL:Lactose or B-YL:Trehalose surfactant by aerosol delivery with a low flow aerosol chamber via their endotracheal tube. Noninvasive aerosolization of DP B-YL:Trehalose surfactant via nasal prongs was tested in spontaneous breathing premature lambs supported with nCPAP. Intratracheal administration of 200 mg/kg of Curosurf®, a liquid porcine surfactant, was used as a positive control. Results Mass median aerosol diameter was 3.6 μm with a geometric standard deviation of 1.8. All four experimental surfactants demonstrated high surface efficacy of intratracheal instillation of a bolus of ~ 100 mg/kg of surfactant with improvement of oxygenation and lung compliance. In the dose–response studies, rabbits received incremental doses of DP B-YL:Lactose or B-YL:Trehalose surfactant intratracheally and showed an optimal response in oxygenation and lung function at a dose of 120–240 mg/kg. Aerosol delivery via nasal prongs of 1 or 2 doses of ~ 100 mg/kg of B-YL:Trehalose surfactant to premature lambs supported with nCPAP resulted in stabilization of spontaneous breathing and oxygenation and lung volumes comparable to the positive control. Conclusion These studies confirm the clinical potential of DP synthetic lung surfactant with B-YL peptide as a SP-B mimic to alleviate surfactant deficiency when delivered as a liquid bolus or as an aerosol.

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Changes in Use of Respiratory Support for Preterm Infants in the US, 2008-2018

Cited by 35 publications

References 32 publications

Respiratory support of infants born at 22–24 weeks of gestational age

Respiratory support of infants born at 22–24 weeks of gestational age

Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies

Efficacy, dose–response, and aerosol delivery of dry powder synthetic lung surfactant treatment in surfactant-deficient rabbits and premature lambs

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