Effect of time and body position on ventilation in premature infants

Hough, Judith; Trojman, Anthony Paul; Schibler, Andreas

doi:10.1038/pr.2016.116

Cited by 26 publications

(23 citation statements)

References 37 publications

(53 reference statements)

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“…The literature indicates that the heart rate also responds to neonatal conditions. Lower mean heart rates of newborns have been demonstrated in the supine position, during active sleep [24], during spontaneous breathing [25] and during ventilator support [17]. However, the infants studied here Oxygen saturation did also not differ between the groups submitted to noninvasive ventilation for 48 and 72 hours.…”

Section: Discussionmentioning

confidence: 45%

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Influence of the duration of noninvasive ventilation on the cardiorespiratory indicators of preterm infants: A randomized clinical trial

Brunherotti¹

2018

Arch Pulmonol Respir Care

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This study aimed to evaluate the cardiorespiratory indicators of preterm infants submitted to two noninvasive ventilator support systems in two periods. It was an controlled randomized clinical trial (RBR-7d9dth). Fifty-two newborns (gestational age of 30.6±2.3 weeks, weight of 1,366±445 g) submitted to continuous positive airway pressure (CPAP) therapy were studied. The infants were randomly allocated to two groups: 31 children received CPAP therapy for 48 hours and 21 children for 72 hours. The respiratory rate, heart rate, oxygen saturation and Silverman-Andersen Score were recorded once a day. Three measurements were obtained in a 15 minutes intervals. The infants were monitored during the predetermined period of noninvasive ventilation and for 24 hours after pressure support withdrawal. The Student t-test was used for comparison of the variables between groups after normality evaluation by the Kolmogorov-Smirnov test and signifi cance was considered when p<0.05. It was found that the birth characteristics were homogenous, without signifi cant differences between groups. The cardiorespiratory indicators did not differ signifi cantly between groups, but better mean values were observed for the 72hour group. There was a difference in the respiratory rate of 5.0 breaths per minute and the heart rate was 7.8 bpm, while oxygen saturation was similar in the two groups. Conclusions: Neither the duration of noninvasive ventilation of 48 or 72 hours nor the nasal CPAP and nasal intermittent positive pressure had an infl uence on the cardiorespiratory indicators of preterm infants. However, the period of 72 hours resulted in lower respiratory and heart rates.

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Section: Discussionmentioning

confidence: 45%

“…So far, no studies have addressed the relationship between the duration of noninvasive ventilation and cardiorespiratory response. Part of the scientifi c studies have focused on the relationship the ventilator support and body position [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Influence of the duration of noninvasive ventilation on the cardiorespiratory indicators of preterm infants: A randomized clinical trial

Brunherotti¹

2018

Arch Pulmonol Respir Care

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“…Leaving all infants in the same position during delivery and post-DR care may reduce the stress of repositioning and may be in line with experimental results. 19 Infants receiving any respiratory support reached their physiological peak in lung function two hour after repositioning independent from their actual position, while spontaneously breathing infants were less affected by relocation. Therefore, prospective studies are needed to evaluate if and when repositioning of an infant may be of advantage.…”

Section: Discussionmentioning

confidence: 98%

Single-centre prospective observational study on postdelivery room care

Hartmann

Bauerschmitz

Küster

2020

bmjpo

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ObjectivesAs quality of care in the delivery room has major impact on outcome of preterm infants, multiple guidelines have been established in recent years. There is, however, little evidence on how to proceed during postdelivery room care, the time of transfer and admission to the neonatal intensive care unit (NICU). The aim of this study was to identify processes taking place during this period with potential impact on outcome.Study designProspective observational study.SettingSingle-centre German tertiary NICU.Patients40 inborn preterm infants undergoing postdelivery room care.Main outcomePrevalence of prolonged duration of postdelivery room care, disconnections from the ventilator and positioning of preterm infants.ResultsTotal duration of postdelivery room care and NICU admission procedures were shorter in infants transferred in a transport incubator compared with using a NICU care station from birth. Extremely low birth weight (ELBW) infants spend 8% of the time in prone position in contrast to 39% in non-ELBW. Total duration of disconnection from the ventilator was 50 s and was ten times longer in infants who had nasal CPAP compared with infants intratracheally intubated. Infants with nCPAP had longer duration of disconnection from the ventilator if body weight was >1000 g or if they were transferred in a transport incubator.ConclusionsMultiple parameters like birth weight or type of transport affect neonatal care during the postdelivery room period. Prospective studies are needed to identify and optimise parameters within this period that affect long-term outcome.

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“…Premature infants managed with NIV can be positioned both supine and prone [126]. Repositioning during the course of ventilation may improve ventilation homogeneity and oxygenation [127][128][129]. However, position changes alter the upper respiratory tract angles and may therefore influence the fate of a nebulized drug.…”

Section: Miscellaneousmentioning

confidence: 99%

Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned

et al. 2021

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Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy.In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population.

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Effect of time and body position on ventilation in premature infants

Cited by 26 publications

References 37 publications

Influence of the duration of noninvasive ventilation on the cardiorespiratory indicators of preterm infants: A randomized clinical trial

Influence of the duration of noninvasive ventilation on the cardiorespiratory indicators of preterm infants: A randomized clinical trial

Single-centre prospective observational study on postdelivery room care

Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned

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