Chronology and Determinants of Respiratory Function Changes Following Administration of Systemic Postnatal Corticosteroids in Extremely Preterm Infants

Dassios, Theodore; Kaltsogianni, Ourania; Hickey, Ann; Bhat, Ravindra; Greenough, Anne

doi:10.1016/j.jpeds.2019.07.062

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…It should be noted that in absolute terms, the values of V A / Q that we are reporting are markedly abnormal with a median V A / Q of 0.20 in the whole cohort including survivors and non-survivors. These values are comparable to premature infants with severe bronchopulmonary dysplasia 21 or pulmonary interstitial emphysema 22 and more than four times lower than what would be seen in healthy term infants using the same methodology (median V A / Q : 0.84). 9 , 10 It was also interesting that although a median shunt of 10% was present in our population, the degree of shunt did not discriminate survivors from non-survivors, nor did it change significantly over the course of neonatal intensive care in the infants who survived to discharge.…”

Section: Discussionsupporting

confidence: 51%

“…In our study, we used two retrospectively collected paired points of SpO 2 and F I O 2 , whereas some previous neonatal studies have used 3–5 prospective pairs. 29 , 30 Two pairs, however, have also been used 9 , 21 , 22 as the higher value of SpO 2 would predominantly define the degree of shunt and the lower value of SpO 2 would adequately define the V A / Q . The retrospective nature of our data, finally, might have left us with fewer paired measurements to calculate the V A / Q and shunt within our narrow time window of 4 h compared to prospectively collected data.…”

Section: Discussionmentioning

confidence: 99%

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Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

et al. 2022

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Background We aimed to explore the postnatal evolution of ventilation/perfusion ratio (VA/Q) and right-to-left shunt in infants with congenital diaphragmatic hernia (CDH) and whether these indices predicted survival to discharge. Methods Retrospective cohort study at King’s College Hospital, London, UK of infants admitted with CDH in 10 years (2011–2021). The non-invasive method of the oxyhaemoglobin dissociation curve was used to determine the VA/Q and shunt in the first 24 h of life, pre-operation, pre-extubation and in the deceased infants, before death. Results Eighty-two infants with CDH (71 left-sided) were included with a median (IQR) gestation of 38.1(34.8–39.0) weeks. Fifty-three (65%) survived to discharge from neonatal care. The median (IQR) VA/Q in the first 24 h was lower in the deceased infants [0.09(0.07–0.12)] compared to the ones who survived [0.28(0.19–0.38), p < 0.001]. In the infants who survived, the VA/Q was lower in the first 24 h [0.28 (0.19–0.38)] compared to pre-operation [0.41 (0.3–0.49), p < 0.001] and lower pre-operation compared to pre-extubation [0.48 (0.39–0.55), p = 0.027]. The shunt was not different in infants who survived compared to the infants who did not. Conclusions Ventilation-to-perfusion ratio was lower in infants who died in the neonatal period compared to the ones that survived and improved in surviving infants over the immediate postnatal period. Impact The non-invasive method of the oxyhaemoglobin dissociation curve was used to determine the ventilation/perfusion ratio VA/Q in infants with congenital diaphragmatic hernia (CDH) in the first 24 h of life, pre-operation, pre-extubation and in the deceased infants, before death. The VA/Q in the first 24 h of life was lower in the infants who did not survive to discharge from neonatal care compared to the ones who survived. In the infants who survived, the VA/Q improved over the immediate postnatal period. The non-invasive calculation of VA/Q can provide valuable information relating to survival to discharge.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

et al. 2022

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“…Dassios et al suggested that more immature infants are less responsive to dexamethasone for preventing BPD when administered after the first week of life. 15 Another small single-centre study showed that maternal chorioamnionitis or intrauterine growth restriction was not associated with the response to hydrocortisone. 16 A Korean single-centre study found that pathological chorioamnionitis and PROM were associated with poor responses to dexamethasone.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the response to postnatal dexamethasone use in very low birthweight infants: a nationwide cohort study

Baek,

Shin,

Han

et al. 2023

bmjpo

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BackgroundDexamethasone is widely used as a systemic corticosteroid to treat and prevent bronchopulmonary dysplasia (BPD) in preterm infants. We evaluated the current epidemiology of dexamethasone use to prevent BPD and analyse the factors associated with the response to dexamethasone in very low birthweight infants using a nationwide database.MethodsWe included very low birthweight infants born between January 2013 and December 2020 with a gestational age of 23–31 weeks using data from the Korean Neonatal Network registry. Patients were grouped based on their dexamethasone use into ‘Dex’ or ‘No Dex’ groups. Clinical variables and data were collected, and the annual trends of dexamethasone use and the proportion of patients who received dexamethasone according to gestational age were analysed. Respiratory outcomes were compared between the groups. Univariate and multivariate analyses were performed to analyse factors associated with the response to dexamethasone in BPD.ResultsOf 11 261 eligible infants, 2313 (20.5%) received dexamethasone, and 1714 (74.1%) of them were diagnosed with moderate-to-severe BPD. The 8-year annual prevalence of dexamethasone use was 17.7–22.3%. The ‘Dex’ group had more moderate-to-severe BPD, more frequent invasive ventilation use at a postmenstrual age of 36 weeks and longer ventilator duration. Birth weight, 5-minute APGAR score, pulmonary hypertension within the first 28 days, surgical treatment of patent ductus arteriosus, medical treatment of patent ductus arteriosus, pathological chorioamnionitis, hydrocortisone or budesonide use, surgical management of necrotising enterocolitis and fungal sepsis were associated with BPD after dexamethasone use.ConclusionsApproximately 20.5% of preterm infants received dexamethasone, and the frequency increased as gestational age decreased. Poor response to dexamethasone was associated with antenatal and postnatal inflammation, low birth weight and early pulmonary hypertension.

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“…A non-invasive gas exchange model characterising the curvilinear best fit of multiple fraction of inspired oxygen (FiO 2 ) and peripheral oxygen saturation (SpO 2 ) pairs relative to an idealised oxyhaemoglobin dissociation curve provides a pragmatic opportunity to quantify V′/Q′ mismatch (figure 1). 9 10 This model has been used to quantify disease severity in BPD11–15 and describe gas exchange after postnatal corticosteroids 16 17. The effects of CPAP level changes on V′/Q′ using this model have not been previously reported.…”

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confidence: 99%

Use of ventilation/perfusion mismatch to guide individualised CPAP level selection in preterm infants: a feasibility trial

Bamat

Orians

Abbasi

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo measure within-subject changes in ventilation/perfusion (V′/Q′) mismatch in response to a protocol of individualised nasal continuous positive airway pressure (CPAP) level selection.DesignSingle-arm, non-randomised, feasibility trial.SettingThree centres in the Children’s Hospital of Philadelphia neonatal care network.PatientsTwelve preterm infants of postmenstrual age 27–35 weeks, postnatal age >24 hours, and receiving a fraction of inspired oxygen (FiO2) >0.25 on CPAP of 4–7 cm H2O.InterventionsWe applied a protocol of stepwise CPAP level changes, with the overall direction and magnitude guided by individual responses in V′/Q′ mismatch, as determined by the degree of right shift (kilopascals, kPa) in a non-invasive gas exchange model. Best CPAP level was defined as the final pressure level at which V′/Q′ improved by more than 5%.Main outcome measuresWithin-subject change in V′/Q′ mismatch between baseline and best CPAP levels.ResultsThere was a median (IQR) within-subject reduction in V′/Q′ mismatch of 1.2 (0–3.2) kPa between baseline and best CPAP levels, p=0.02. Best CPAP was observed at a median (range) absolute level of 7 (5–8) cm H2O.ConclusionsNon-invasive measures of V′/Q′ mismatch may be a useful approach for identifying individualised CPAP levels in preterm infants. The results of our feasibility study should be interpreted cautiously and replication in larger studies evaluating the impact of this approach on clinical outcomes is needed.Trial registration numberNCT02983825.

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Chronology and Determinants of Respiratory Function Changes Following Administration of Systemic Postnatal Corticosteroids in Extremely Preterm Infants

Cited by 7 publications

References 30 publications

Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

Factors associated with the response to postnatal dexamethasone use in very low birthweight infants: a nationwide cohort study

Use of ventilation/perfusion mismatch to guide individualised CPAP level selection in preterm infants: a feasibility trial

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