Interventions for the Management of Respiratory Distress in Late Preterm and Term Infants Experiencing Delayed Respiratory Transition

Abstract

Objectives To examine the best available evidence for interventions used to manage mild to moderate respiratory distress in late preterm and term infants experiencing delayed respiratory transition. Data Sources EMBASE, MEDLINE, Cochrane Review, Joanna Briggs, PubMed, CINAHL, and Google Scholar online databases were searched for articles related to delayed respiratory transition. Reference lists were reviewed to identify additional articles for inclusion. Study Selections Randomized, blinded, placebo-controlled, randomized prospective, prospective observational, and retrospective cohort studies published in English-language, peer-reviewed journals between 2007 and August 2017 were reviewed for inclusion. Studies were included if they examined respiratory focused interventions that could potentially prevent admission to the neonatal intensive care unit (NICU) of the term or late preterm infant transitioning to extrauterine life. Data Extraction The CASP tools were utilized for appraisal of individual studies. Data were extracted from the 5 studies included in this review. Data Synthesis In 4 of the 5 studies, prevention of NICU admission was the primary aim. The observational study observed videos of newborn resuscitations and described the effect of early intervention with continuous positive-airway pressure (CPAP) ventilation on prevention of NICU admission for respiratory distress. One randomized controlled trial used adrenaline injections to prevent development of respiratory distress. The 3 remaining randomized controlled trials used prophylactic CPAP or sustained inflation as a method for preventing development of delayed respiratory transition. Three of the 5 studies focused exclusively on cesarean born infants. Among the interventions studied, early or prophylactic CPAP shows the most promise for prevention of NICU admission in late preterm and term infants with mild to moderate respiratory distress. Conclusion The lack of safety and efficacy data for either adrenaline injections or prophylactic CPAP precludes either method for current use in the prevention of respiratory distress for the late preterm or term infant transitioning to extrauterine life. Two randomized trials, both using prophylactic CPAP, had a significant decrease in NICU admissions. Both studies were conducted at a single center and exclusive to infants born by cesarean delivery. A single study using sustained lung inflation showed no significant difference in the need for respiratory support or NICU admission. A single study using adrenaline also showed no benefit to the prevention of respiratory distress related to transition. Further multicenter randomized controlled trials are needed before broad adoption of early or prophylactic CPAP can be recommended.

Bi-Level Positive Airway Pressure for Non-invasive Respiratory Support of Foals

“…The use of non-invasive ventilation (NIV) is now widely regarded as the most effective approach for respiratory support of human neonates ( 4 , 5 ), with continuous positive airway pressure (CPAP) shown to reduce the number of preterm infants requiring admission to neonatal intensive care ( 6 ), and to decrease the risk of bronchopulmonary dysplasia or death in neonates requiring respiratory support ( 7 ). The technique involves the delivery of a constant positive (greater than atmospheric) pressure to the airway and preserves spontaneous respiration.…”

Outcome of Continuous Positive Airway Pressure (CPAP) Administration in Delivery Room for Neonates with ≧35 Weeks of Gestational Age with Respiratory Distress: A Randomized Control Trial in a Tertiary Care Hospital

“…A sample size of 130 neonates was calculated based on the systematic review of the effects of interventions in the term and late preterm infants experiencing delayed respiratory transition based on the following formula n = f(α/2, β) × [ p 1 × (100 − p 1) + p 2 × (100 − p 2)] / ( p 2 − p 1) 2 ]. 12…”

Perinatal predictors of clinical instability at birth in late-preterm and term infants

“…Predicting which infants may benefit from a senior's presence is challenging. Delays in recognising and/or effectively supporting a compromised infant increase the risk of neonatal morbidity and infant-mother separation [2,3]. Accurate identification of infants at risk of needing more advanced stabilisation may inform hospital policies and ensure the best utilisation of staff.…”