Manual Ventilation with a Few Large Breaths at Birth Compromises the Therapeutic Effect of Subsequent Surfactant Replacement in Immature Lambs

Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury

“…It is well established that five large rapid inflations (> 8 ml/kg) at birth are sufficient to cause lung injury (49) and to initiate a systemic inflammatory cascade in the neonate (50). The bag-and-mask or T-piece circuits commonly used for neonatal resuscitation provide no feedback information on the V T being delivered.…”

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

“…Clinical studies of SI have suggested a reduced need for surfactant replacement following a SI (24)(25)(26). However, in preterm lambs, pretreatment with surfactant improves the lung injury patterns and response to a SI compared with post-SI surfactant (12), suggesting a recruitment maneuver may also influence subsequent respiratory therapies (8). The interplay of Articles antenatal steroids with intentional recruitment maneuvers is even less well understood.…”

“…Ideally, lung protective respiratory support should commence during transition to ex utero life (1,8). During this period, the infant must rapidly clear lung liquid, aerate the lung, establish a functional residual capacity, and commence tidal ventilation, processes influenced by the intrinsic mechanical properties of the lung as well as the applied respiratory strategy (5,6,9-13).…”

“…The roles of early exogenous surfactant therapy (2) and antenatal corticosteroids (3) in improving lung mechanics, functional residual capacity, and reducing respiratory support are well established. The optimal respiratory support strategies are still debated (4-7).Ideally, lung protective respiratory support should commence during transition to ex utero life (1,8). During this period, the infant must rapidly clear lung liquid, aerate the lung, establish a functional residual capacity, and commence tidal ventilation, processes influenced by the intrinsic mechanical properties of the lung as well as the applied respiratory strategy (5,6,9-13).…”

Incidence and Outcome of Surfactant Therapy in Premature Neonates in ICU of KAMC

“…Surfactant replacement was established as an effective and safe therapy for immaturity-related surfactant deficiency by early 1990s (Engle, 2008). Mechanical ventilation is frequently needed for the management of respiratory distress syndrome even though the lung injury induced by the ventilator can lead to ineffective production of endogenous surfactant thus reflects the prognostication of surfactant replacement therapy (Bjorklund et al, 1997). Direct tracheal instillation of surfactant has shown a reduce in death rate and morbidity rate in infants with RDS (Berry et al, 1994).…”