Comparative Study of the Effects of Continuous Positive Airway Pressure and Nasal High-Flow Therapy on Diaphragmatic Dimensions in Preterm Infants

El-Mogy, Mohamed M.; El-Halaby, Hanan; Attia, Gehan; Abdel‐Hady, Hesham

doi:10.1055/s-0037-1608682

Cited by 14 publications

(9 citation statements)

References 37 publications

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“…Despite very few studies have evaluated the diaphragmatic function in VPI on noninvasive ventilation, the diaphragmatic measurements found in our study are consistent with the previous publications 28–30 . We also found a significant positive correlation between diaphragmatic thickness and anthropometric data as reported, 31 but we did not find association between DTF and MAP, LUS score, SF ratio, or need for surfactant treatment when assessed in the first 2 h of life and after caffeine administration.…”

Section: Discussionsupporting

confidence: 92%

“…25 , and yet may be very useful in other settings as reported by Nanda et al 27 Despite very few studies have evaluated the diaphragmatic function in VPI on noninvasive ventilation, the diaphragmatic measurements found in our study are consistent with the previous publications. [28][29][30] We also found a significant positive correlation between diaphragmatic thickness and anthropometric data as reported, 31 Optimizing antenatal care, avoiding intubation in delivery room, caffeine and early surfactant with a less invasive technique when needed, are proven strategies or "bundles" to reduce BPD. 5,37 Categorizing a continuous variable leads to loss of information and can reduce the validity of the conclusions derived from a single study.…”

Section: Discussionsupporting

confidence: 70%

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Lung ultrasound for early surfactant treatment: Development and validation of a predictive model

Aldecoa‐Bilbao¹,

Balcells-Esponera

Barbero³

et al. 2020

Pediatric Pulmonology

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Aim: To develop and validate a feasible predictive model for early surfactant treatment in very preterm infants (VPI) admitted with respiratory distress syndrome (RDS). Methods: Preterm infants less than 32 weeks of gestation with RDS and stabilized with noninvasive ventilation in delivery room were recruited (January 2018-April 2020). Clinical data, chest X-ray (CXR) score, respiratory support, oxygen saturation/fraction of inspired oxygen ratio (SF ratio), lung ultrasound (LUS) score, and diaphragmatic thickening fraction (DTF) were recorded at 60-120 min of life. Oxygen threshold for surfactant administration was fraction of inspired oxygen more than 30%; ultrasound findings were blinded. Logistic regression models using a stepwise selection of variables were developed in the derivation cohort. Coefficients from these models were applied to the validation cohort and a diagnostic performance was calculated. Results: A total of 144 VPI with a mean gestational age of 28.7 ± 2.2 weeks were included (94 into the derivation cohort, 50 into the validation cohort); 37 required surfactant treatment (25.7%). Gestational age, SF ratio, LUS score, CXR score, and Silverman score were related to surfactant administration (R 2 = .823). Predictors included in the final model for surfactant administration were SF ratio and LUS score (R 2 = .783) with an area under the receiver operating characteristic (AUC) = 0.97 (95% confidence interval [CI]: 0.93-1.00) in the derivation cohort and an AUC = 0.95 (95% CI: 0.85-0.99) in the validation cohort. By applying our predictive model, 26 patients (70.2%) would have been treated with surfactant earlier than 2 h of life. Conclusion: The predictive model showed a high diagnostic performance and could be of value to optimize early respiratory management in VPI with RDS.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 70%

Lung ultrasound for early surfactant treatment: Development and validation of a predictive model

Aldecoa‐Bilbao¹,

Balcells-Esponera

Barbero³

et al. 2020

Pediatric Pulmonology

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“…Several randomized crossover studies have attempted to investigate the effects of NCPAP and HFNC on physiological parameters. These studies revealed no differences in heart and respiratory rate, FiO 2 levels, oxygen saturation, work of breathing, thoraco‐abdominal asynchrony, or electrical activity of the diaphragm . However, the studies included more mature infants clinically stable on NCPAP for several days at the time of the measurements.…”

Section: Discussionmentioning

confidence: 99%

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

Latremouille

Shalish

Kanbar³

et al. 2019

Pediatric Pulmonology

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Background NCPAP and High flow nasal cannula (HFNC) are common modes of non‐invasive respiratory support used after extubation. Heart rate variability (HRV) has been demonstrated as a marker of well‐being in neonates and differences in HRV were described in preterm infants receiving respiratory care. The objective was to investigate the effects of NCPAP and HFNC on HRV after extubation. Methods Randomized crossover trial in infants with birth weight (BW) ≤1250 g after undergoing their first elective extubation. ECG recordings were performed during 45 min while on HFNC and nasal continuous positive airway pressure (NCPAP). Time domain, non‐linear, and frequency domain parameters were calculated and compared during HFNC and NCPAP using paired nonparametric tests. A secondary analysis was performed in the subgroup of infants that were successfully extubated. Results Thirty infants with median [range] gestational age of 27 weeks [24.1‐29.3] and BW of 930 g [610‐1220] were studied at 5 days [1‐39] of age. No differences in HRV parameters were observed between HFNC and NCPAP. In the secondary analysis, infants successfully extubated (n = 27) had a significantly higher HRV during HFNC for some time domain parameters. For instance, the standard deviation of the RR intervals (SDRR) was more likely to be higher during HFNC compared to NCPAP (HFNC: 18/27 vs NCPAP: 9/27, P = 0.017) . Conclusion During the first hours after extubation, no differences in HRV were detected between HFNC and NCPAP in the overall cohort. However, a significantly higher HRV was noted during HFNC in the subgroup of infants successfully extubated.

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“…Neonatologists check diaphragmatic excursions by US mainly to rule out absent or paradoxical motion, but limited information on diaphragmatic kinetics is available in healthy full‐term and preterm neonates . Compliance of the respiratory system plays an important role in diaphragmatic motion, and pulmonary disease is associated with respiratory muscle dysfunction .…”

Section: Discussionmentioning

confidence: 99%

Right Diaphragmatic Peak Motion Velocities on Pulsed Wave Tissue Doppler Imaging in Neonates: Method, Reproducibility, and Reference Values

Radicioni

Rinaldi

Camerini

et al. 2019

J of Ultrasound Medicine

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Objectives-To test the reproducibility and report the reference ranges of the right diaphragmatic excursion's peak velocities recorded by pulsed wave tissue Doppler imaging in healthy term neonates.Methods-We formerly assessed intraobserver and interobserver variability of the method for the right hemidiaphragm in a small group of neonates, including ventilated neonates. We did not attempt to test the approach for the left hemidiaphragm because of the recognized high failure rate of visualization. Next, we recorded the peak velocities of both hemidiaphragms throughout inspiration and expiration in 229 healthy term neonates near birth to establish weight-dependent reference ranges for the measurements.Results-The study population included 116 male and 113 female neonates. The reproducibility of the technique was excellent even in neonates supported by ventilation. We always recorded the right diaphragmatic peak velocities in the normative study group, whereas the left ones were only recorded in 110 of 229 (48%) and 148 of 229 (65%) neonates from the anterior and lateral views, respectively. The modality of delivery and sex showed no influence on diaphragmatic kinetics. The mean inspiratory peak velocities AE SD were 1.4 AE 0.2 cm/s for the right hemidiaphragm and 1.5 AE 0.3 cm/s for the left hemidiaphragm. The mean expiratory peak velocities were 1.3 AE 0.2 cm/s for the right hemidiaphragm and 1.4 AE 0.3 cm/s for the left hemidiaphragm.Conclusions-Measurement of right diaphragmatic kinetics as assessed by pulsed wave tissue Doppler imaging was found to be a reliable technique. Its clinical applicability for the prompt diagnosis and effective management of neonatal respiratory failure deserves further investigation.

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Comparative Study of the Effects of Continuous Positive Airway Pressure and Nasal High-Flow Therapy on Diaphragmatic Dimensions in Preterm Infants

Abstract: Registry name: Clinical Trials.gov. Registration number: NCT02421328. Web link to study on registry: https://clinicaltrials.gov/ct2/show/NCT02421328.

Cited by 14 publications

References 37 publications

Lung ultrasound for early surfactant treatment: Development and validation of a predictive model

Lung ultrasound for early surfactant treatment: Development and validation of a predictive model

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

Right Diaphragmatic Peak Motion Velocities on Pulsed Wave Tissue Doppler Imaging in Neonates: Method, Reproducibility, and Reference Values

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