Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth

Abstract

Background: Preterm infants are commonly supported with 5–8 cmH2O CPAP. However, animal studies demonstrate that high initial CPAP levels (12–15 cmH2O) which are then reduced (termed physiological based (PB)-CPAP), improve lung aeration without adversely affecting cardiovascular function. We investigated the feasibility of PB-CPAP and the effect in preterm infants at birth.Methods: Preterm infants (24–30 weeks gestation) were randomized to PB-CPAP or 5–8 cmH2O CPAP for the first 10 min after birth. PB-CPAP consisted of 15 cmH2O CPAP that was decreased when infants were stabilized (heart rate ≥100 bpm, SpO2 ≥85%, FiO2 ≤ 0.4, spontaneous breathing) to 8 cmH2O with steps of ~2/3 cmH2O/min. Primary outcomes were feasibility and SpO2 in the first 5 min after birth. Secondary outcomes included physiological and breathing parameters and short-term neonatal outcomes. Planned enrollment was 42 infants.Results: The trial was stopped after enrolling 31 infants due to a low inclusion rate and recent changes in the local resuscitation guideline that conflict with the study protocol. Measurements were available for analysis in 28 infants (PB-CPAP n = 8, 5–8 cmH2O n = 20). Protocol deviations in the PB-CPAP group included one infant receiving 3 inflations with 15 cmH2O PEEP and two infants in which CPAP levels were decreased faster than described in the study protocol. In the 5–8 cmH2O CPAP group, three infants received 4, 10, and 12 cmH2O CPAP. During evaluations, caregivers indicated that the current PB-CPAP protocol was difficult to execute. The SpO2 in the first 5 min after birth was not different [61 (49–70) vs. 64 (47–74), p = 0.973]. However, infants receiving PB-CPAP achieved higher heart rates [121 (111–130) vs. 97 (82–119) bpm, p = 0.016] and duration of mask ventilation was shorter [0:42 (0:34–2:22) vs. 2:58 (1:36–6:03) min, p = 0.020]. Infants in the PB-CPAP group required 6:36 (5:49-11:03) min to stabilize, compared to 9:57 (6:58–15:06) min in the 5–8 cmH2O CPAP group (p = 0.256). There were no differences in short-term outcomes.Conclusion: Stabilization of preterm infants with PB-CPAP is feasible but tailoring CPAP appeared challenging. PB-CPAP did not lead to higher SpO2 but increased heart rate and shortened the duration of mask ventilation, which may reflect faster lung aeration.

The Effect of a Higher Bias Gas Flow on Imposed T-Piece Resistance and Breathing in Preterm Infants at Birth

“…Signals were collected by the New Life BOX Neo-RDS (Applied Biosignals, Weener, Germany) connected to the RFM and saved by Polybench software (Applied Biosignals, Weener, Germany). Pulmochart software (Applied Biosignals, Weener, Germany) allowed a breath-by-breath analysis to calculate breathing parameters, corrected for birth weight ( 12 ).…”

Possibility of using non-invasive modes of respiratory support at the stages of interhospital transportation of newborns

“…Наиболее широко изученный вариант неинвазивной респираторной поддержки у недоношенных детей -это спонтанное дыхание с постоянным положительным давлением в дыхательных путях, создаваемым в носовых канюлях (nasal continuous positive airway pressure, nCPAP), который был исследован в качестве первичной формы респираторной поддержки и продолжающейся поддержки после экстубации. Создаваемое давление обеспечивает стабильность дыхательных путей и поддержание функциональной остаточной емкости [21,22]. Описаны различные механизмы действия, включая улучшение активности диафрагмы, повышение эластичности легких и снижение сопротивления дыхательных путей.…”

“…Описаны различные механизмы действия, включая улучшение активности диафрагмы, повышение эластичности легких и снижение сопротивления дыхательных путей. Конечным результатом является уменьшение работы дыхания, снижение частоты апноэ и сохранение сурфактанта на альвеолярной поверхности [22,23] [25,26]. Наиболее эффективный метод эндотрахеального введения сурфактанта через тонкий катетер позволяет исключить эпизод принудительного дыхания через интубационную трубку, обеспечивая поддержку спонтанного дыхания с помощью nCPAP, при постепенном введении сурфактанта.…”