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

Subramaniam, Prema; Dj, Henderson-Smart; Davis, PG

doi:10.1002/14651858.cd001243

Cited by 47 publications

(48 citation statements)

References 7 publications

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“…Nasal CPAP is an effective treatment modality for neonates with bronchopulmonary dysplasia (BPD) and respiratory disease [3]. External or internal complications of nCPAP and High Flow can be relatively frequent and close surveillance for potential complications must be considered during nCPAP and High flow use.…”

Section: Assessment Tool For Babiesmentioning

confidence: 99%

An Assessment Tool for Babies Requiring Continuous Positive Airway Pressure or High Flow

Lamburne¹

2016

Clinics Mother Child Health

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Section: Assessment Tool For Babiesmentioning

confidence: 99%

An Assessment Tool for Babies Requiring Continuous Positive Airway Pressure or High Flow

Lamburne¹

2016

Clinics Mother Child Health

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“…These include (a) avoidance of intubation and mechanical ventilation by use of CPAP or non-invasive ventilation, (b) synchronised mechanical ventilation with positive pressure infl ations and spontaneous inspiration coinciding, with the adequate gas exchange being achieved at lower peak pressures reducing the likelihood of barotrauma, and (c) reduction in excessive volume delivery, thus reducing the likelihood of volutrauma, using either volume-targeted ventilation (VTV) or high-frequency oscillation (HFO). Observational studies highlighted that the use of early CPAP rather than intubation and ventilation was associated with a lower incidence of BPD, but that effect was not confi rmed by a meta-analysis [85] or by the results of three more recently reported large RCTs [55,71,86] . A meta-analysis of six RCTs demonstrated that intubation and early surfactant followed by extubation to CPAP compared with later selective surfactant was associated with a lower incidence of mechanical ventilation, air-leak syndromes and BPD [82] .…”

Section: Ventilation Strategiesmentioning

confidence: 99%

Perinatal prevention of bronchopulmonary dysplasia

Greenough

Ahmed

2012

Journal of Perinatal Medicine

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Bronchopulmonary dysplasia (BPD), defi ned as oxygen dependency for at least 28 days after birth, is a common adverse outcome of very premature birth. Affected children require frequent readmissions to hospital in the fi rst 2 years, and although lung growth and remodelling results in progressive improvement in lung function, airfl ow abnormalities may remain. Indeed, the most severely affected experience troublesome respiratory symptoms as adolescents and young adults. As a consequence, many potential preventative strategies have been investigated, and some have resulted in a reduction in BPD but with a negative risk/benefi t ratio, for example, postnatal corticosteroids. Others therapies, namely antenatal corticosteroids and postnatal surfactant, have resulted in signifi cant benefi ts to infants, including reductions in respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and neonatal death, but have not impacted favourably on the incidence of BPD, perhaps due to the increased survival of very immature infants. In one major trial, it has been shown that BPD can be reduced without adverse effects by caffeine administration. Avoidance of high oxygen concentrations at resuscitation is also a promising approach to reduce BPD.

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“…Interestingly, the use of prophylactic NCPAP for the management of RDS in preterm infants in the presurfactant era reported no differences in BPD. 23 Finally, NCPAP has been successfully used in neonates during air-or road-based transports, and following surfactant therapy.…”

Section: Nasal Cpapmentioning

confidence: 99%

Nasal respiratory support through the nares: its time has come

Ramanathan

2010

J Perinatol

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Respiratory distress syndrome (RDS) is the most common respiratory morbidity in preterm infants. Surfactant therapy and invasive mechanical ventilation through the endotracheal tube (ETT) have been the cornerstones in RDS management. Despite improvements in the provision of mechanical ventilation, bronchopulmonary dysplasia (BPD), a multifactorial disease in which invasive mechanical ventilation is a known contributory factor, remains an important cause of morbidity among preterm infants. Barotrauma, volutrauma or oxygen-induced lung inflammation (oxy-trauma) contributes significantly to the development of BPD in neonates ventilated through an ETT. Recently, nasal respiratory support has been increasingly used in preterm infants in an attempt to decrease post-extubation failure and, perhaps, BPD, and for the treatment of apnea of prematurity in nonventilated neonates. Observational studies using noninvasive respiratory support, such as nasal continuous positive airway pressure (NCPAP), have shown a decrease in the incidence of BPD when used to avoid intubation or minimize the duration of invasive mechanical ventilation through the ETT. Moreover, synchronized as well as nonsynchronized nasal intermittent positive-pressure ventilation (NIPPV) have been shown to significantly decrease post-extubation failure compared with NCPAP and their use has been associated with a reduced risk of BPD in small randomized controlled clinical trials. More recently, early surfactant administration followed by extubation to NIPPV has been suggested to be synergistic in decreasing BPD. Although these findings are promising, additional studies evaluating different nasal interfaces, flow synchronization, synchronization using neurally adjusted ventilatory assist mode, and closed loop control of oxygen during nasal ventilation to minimize lung injury are needed in an attempt to further decrease the incidence of lung injury in preterm neonates requiring respiratory support.

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

Cited by 47 publications

References 7 publications

An Assessment Tool for Babies Requiring Continuous Positive Airway Pressure or High Flow

An Assessment Tool for Babies Requiring Continuous Positive Airway Pressure or High Flow

Perinatal prevention of bronchopulmonary dysplasia

Nasal respiratory support through the nares: its time has come

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