Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants

Subramaniam, Prema; Ho, Jacqueline J; Davis, Peter G

doi:10.1002/14651858.cd001243.pub3

Cited by 195 publications

(152 citation statements)

References 45 publications

Supporting

Mentioning

138

Contrasting

Unclassified

Order By: Relevance

“…The use of INSURE and CPAP/NIPPV for preterm infants on CPAP with respiratory distress within 48 h after birth and requiring 30–39% oxygen increased with GA in each network. The high use of CPAP/NIPPV in infants born at 25–28 weeks’ GA reflects current evidence suggesting that early CPAP reduces the incidence of BPD compared to mechanical ventilation [21]. The high rate of units in networks using INSURE also reflects evidence from systematic reviews suggesting it reduces BPD compared to mechanical ventilation [22].…”

Section: Discussionmentioning

confidence: 96%

Respiratory Management of Extremely Preterm Infants: An International Survey

et al. 2018

View full text Add to dashboard Cite

Background: There are significant international variations in chronic lung disease rates among very preterm infants yet there is little data on international variations in respiratory strategies. Objective: To evaluate practice variations in the respiratory management of extremely preterm infants born at < 29 weeks’ gestational age (GA) among 10 neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of Neonates collaboration. Methods: A web-based survey was sent to the representatives of 390 neonatal intensive care units from Australia/New Zealand, Canada, Finland, Illinois (USA), Israel, Japan, Spain, Sweden, Switzerland, and Tuscany (Italy). Responses were based on practices in 2015. Results: Overall, 321 of the 390 units responded (82%). The majority of units within networks (40–92%) mechanically ventilate infants born at 23–24 weeks’ GA on continuous positive airway pressure (CPAP) with 30–39% oxygen in respiratory distress within 48 h after birth, but the proportion of units that offer mechanical ventilation for infants born at 25–26 weeks’ GA at similar settings varied significantly (20–85% of units within networks). The most common respiratory strategy for infants born at 27–28 weeks’ GA on CPAP with 30–39% oxygen with respiratory distress within 48 h after birth used by units also varied significantly among networks: mechanical ventilation (0–60%), CPAP (3–82%), intubation and surfactant administration with immediate extubation (0–75%), and less invasive surfactant administration (0–68%). Conclusions: There are marked variations but also similarities in respiratory management of extremely preterm infants between networks. Further collaboration and exploration is needed to better understand the association of these variations in practice with pulmonary outcomes.

show abstract

Section: Discussionmentioning

confidence: 96%

Respiratory Management of Extremely Preterm Infants: An International Survey

et al. 2018

View full text Add to dashboard Cite

show abstract

“…CPAP has been used for over 40 years with early trials showing that it improves oxygenation, regulates breathing and is effective at reducing reintubation following extubation [90]. CPAP is now recommended as the optimal first mode of respiratory support although other modes of non-invasive support from birth are being tested in clinical trials [91]. …”

Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

View full text Add to dashboard Cite

As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

show abstract

“…During the second period there was a significant reduction in the proportion of multiple gestations ( p < 0.003) and outborn patients ( p < 0.001), and a significant increase in antenatal steroid administration ( p < 0.001). Although the global rate of caesarean section was similar in both periods, there was an increase among patients with 23 0 to 26 6 weeks of GA in the second period that was highly significant (p < 0.001). As shown in Table 2 , interventions in the DR significantly changed in the second period.…”

Section: Discussionmentioning

confidence: 82%

“…All the information analysed for the 2 periods 2002-2006 and 2007-2011 was retrieved and compared. Patients with major congenital anomalies, those who died in the delivery room (DR), and infants <23 0 or >34 6 weeks of gestational age (GA) were excluded. Major malformations were listed and coded in the manual of operations, and when a lethal or life-threatening defect was not included in the list, the investigator had to describe it in a free text.…”

Section: Patientsmentioning

confidence: 99%

“…The most recent ILCOR 2015 [5] guidelines and the European Consensus Guidelines [4] recommend a gentle approach to the initial stabilization and respiratory support during neonatal resuscitation and judicious use of supplemental oxygen. Thus, a recent meta-analysis showed that early use of nasal continuous positive airway pressure (CPAP) reduced the need for mechanical ventilation and surfactant administration, and the incidence of death and/or bronchopulmonary dysplasia (BPD) in VLBW infants [6] .…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain

Rodrigo

Martínez²,

Fernández³

et al. 2017

Neonatology

View full text Add to dashboard Cite

Background: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. Objectives: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). Methods: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants <23⁰ or >34⁶ weeks of gestational age (GA) were excluded. Results: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of “outborn” patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (23⁰ to 26⁶ weeks' GA) from 26.6 to 31.6% (p < 0.001). Conclusions: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.

show abstract

Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants

Cited by 195 publications

References 45 publications

Respiratory Management of Extremely Preterm Infants: An International Survey

Respiratory Management of Extremely Preterm Infants: An International Survey

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain

Contact Info

Product

Resources

About