New Developments in Respiratory Support for Preterm Infants

Abstract

The evolution of neonatal respiratory support has been one of the cornerstones for the advancements in neonatal–perinatal medicine, allowing survival of infants previously considered not viable. There is an increasing focus on developing strategies which are not only lifesaving but also minimize lung and other organ systems injury, thereby reducing long-term morbidities. Respiratory support immediately after birth is an area that had lagged behind in terms of evidence base and technological advancements until recently. Some of these advancements include use of a respiratory function monitors for measuring flow and tidal volume, new evidence for oxygen supplementation and monitoring, and the efforts to formulate an ideal strategy for establishing functional residual capacity after birth. Increasing evidence for the benefits of avoiding invasive ventilation on reduction of bronchopulmonary dysplasia has resulted in efforts to further reduce the need for endotracheal intubation by applying newer strategies such as less invasive surfactant instillation, noninvasive high-frequency oscillatory ventilation, or use of high flow nasal cannula oxygen. For infants requiring mechanical ventilation, newer strategies such as volume targeted ventilation or neurally adjusted ventilation are being evaluated to reduce ventilator induced lung injury. Despite these advances, there are significant challenges, including lack of conclusive evidence base for many of currently used respiratory strategies, no reduction in the incidence of bronchopulmonary dysplasia in the last decade, and difficulties in defining outcome measures that better reflect long-term respiratory health.

Manejo de anestesia total endovenosa en un paciente prematuro con displasia broncopulmonar: Un reporte de caso

“…Los criterios diagnósticos y su severidad se establece clínicamente de acuerdo al requerimiento de oxígeno suplementario durante los primeros 28 días de vida ó a las 36 semanas de edad post-concepcional [1]. La intubación Fuente: Autores agradecen a John Wiley e hijos por el permiso para reproducir el esquema de infusión endotraqueal y la ventilación mecánica son los principales factores de riesgo para DBP, por lo que utilizar soporte ventilatorio no invasivo parece ser una estrategia útil para evitar la incidencia de la misma y mejorar la supervivencia en bebés prematuros [7]. En las últimas décadas, se han ido desarrollando nuevos modos ventilatorios tratando de disminuir la lesión al parénquima pulmonar, por medio de frecuencias elevadas y pequeños volúmenes como lo hace la VOAF [7].…”

Predicting Lung Health Trajectories for Survivors of Preterm Birth

“…There has been an increasing shift away from endotracheal intubation to less invasive forms of ventilation such as nasal continuous positive airway pressure (CPAP) and heated humidified high flow nasal cannula (HFNC) (69). This move has been driven by an effort to avoid the more detrimental effects endotracheal intubation such as barotrauma and volutrauma, and has been shown to have a small but significant effect on reducing the risk of developing BPD, although with unclear impacts on long term respiratory function (70).…”

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

“…The lung bioavailability of these drugs could be increased significantly if these drugs were administered directly to the pulmonary site of action via aerosol delivery, thereby reducing the undesired systemic exposure of some medications [16]. Moreover, in the case of surfactant replacement therapy, aerosol delivery could mitigate the associated iatrogenic risks of intubation for intrapulmonary surfactant delivery, and sustain the beneficial effect of non-invasive respiratory support [17][18][19]. Moreover, the development of a method to deliver aerosolized drugs efficiently to premature infants could also give rise to new pharmacological therapies.…”