“Minitouch” treatment of very low‐birth‐weight infants

Abstract

In a cohort study with historical controls of non-asphyxiated very low-birth-weight infants (birth weight < or = 1500 g and gestational age < 33 completed weeks), we evaluated the use of a "minitouch" regime for stabilization after birth and treatment of respiratory distress. This combination of early (prophylactic) treatment with nasal continuous positive airway pressure and minimal handling was introduced as a routine in our Department in 1986. We compared infants born in 1987 and in 1985, when ventilator treatment was used initially in all infants with progressing respiratory distress. The frequency of mechanical ventilation was reduced significantly from 76% in 1985 to 35% in 1987 (p = 0.00001). This reduction reflected the smaller number of infants who received ventilator treatment for less than one week, whereas the frequency of long-term ventilator treatment remained unchanged. Intracranial haemorrhage grade II-IV was reduced from 49% in 1985 to 25% in 1987 (p = 0.01). Mortality rate, average duration of hospitalization, number of infants with pneumothorax, patent ductus arteriosus, need for oxygen at 28 days and number of surviving infants with handicap did not differ significantly between the two study periods. Septicaemia was diagnosed in 16% of the infants in 1987 versus 7% in 1985 (p = 0.045). This difference coincided with an increased use of total parenteral nutrition (18% in 1987 versus 3% in 1985, p = 0.007). We conclude that the minitouch regime prevents progression of respiratory distress, reduces the need for ventilator treatment and is a safe and convenient alternative to mechanical ventilation in preterm infants with mild respiratory problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] To avoid collinearity with GA, BW was converted to BW z-score. 28 The adjusted risk difference (RD) and number needed to treat (NNT) were obtained from the adjusted RR and the proportion of DR intubation before SUPPORT.…”

Impact of Implementing 5 Potentially Better Respiratory Practices on Neonatal Outcomes and Costs

“…Provision of CPAP in the delivery room reduces the need for intubation and subsequent mechanical ventilation of premature infants [5][6][7][8][9][10][11]21 and may decrease the incidence of BPD 8,9,11 but is successful in avoiding early mechanical ventilation in only 31% of infants born before 26 weeks' gestation. 12 Because infants who require mechanical ventilation for management of RDS have improved outcomes if they receive early surfactant, 22,23 we decided to intubate and provide surfactant in the delivery room for all infants born before 26 weeks' gestation but to start CPAP in the delivery room for breathing but distressed infants born at Ն26 weeks' gestation.…”

“…These strategies include the provision of CPAP in the delivery room [5][6][7][8][9][10][11] and early extubation from mechanical ventilation to CPAP. 16 However, the growing body of supportive evidence has not resulted in widespread adoption of either of these strategies in US NICUs.…”

“…Mechanical ventilation increases the risk of subsequent bronchopulmonary dysplasia (BPD), 2 a chronic lung disease associated with adverse pulmonary and neurodevelopmental outcomes. 3,4 On the other hand, early treatment with CPAP can preserve endogenous surfactant and reduce the need for mechanical ventilation and surfactant administration [5][6][7][8][9][10][11] but may be insufficient support for infants born before 26 weeks' gestation. 12 Although there is a growing body of evidence to guide decision making, there is not yet consensus on the best treatment approach for RDS.…”

Effectiveness of Early Use of Spontaneous Respiration Under Continuous Positive Airway Pressure in Premature Infants With Very Low Body Weight at Birth

“…В большинстве работ речь идет о снижении частоты механической вентиляции и длительности кислород-ной зависимости [2,[5][6][7][8].…”