Spontaneous Breathing Patterns of Very Preterm Infants Treated With Continuous Positive Airway Pressure at Birth

Pas, Arjan B. te; Davis, Peter G; Kamlin, C. Omar F.; Dawson, Jennifer A; O'Donnell, Barry; Morley, Colin J

doi:10.1203/pdr.0b013e31817d9c35

Cited by 71 publications

(47 citation statements)

References 53 publications

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“…more air is inspired than exhaled [45]. ‘Air-trapping' could occur due to braking of expiration, which was described previously as ‘frog breathing' [46,47,48]. Karlberg and Koch [47], using chest X-rays and reverse plethysmography, described the first breath as a deeper and slower breath than subsequent breaths, composed of a large inspiration followed by a braked, slow expiration.…”

Section: Pulmonary Transitionmentioning

confidence: 99%

Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

Roest

Siew

et al. 2014

Neonatology

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The transition to life after birth is characterized by major physiological changes in respiratory and hemodynamic function, which are predominantly initiated by breathing at birth and clamping of the umbilical cord. Lung aeration leads to the establishment of functional residual capacity, allowing pulmonary gas exchange to commence. This triggers a significant decrease in pulmonary vascular resistance, consequently increasing pulmonary blood flow and cardiac venous return. Clamping the umbilical cord also contributes to these hemodynamic changes by altering the cardiac preload and increasing peripheral systemic vascular resistance. The resulting changes in systemic and pulmonary circulation influence blood flow through both the oval foramen and ductus arteriosus. This eventually leads to closure of these structures and the separation of the pulmonary and systemic circulations. Most of our knowledge on human neonatal transition is based on human (fetal) data from the 1970s and extrapolation from animal studies. However, there is renewed interest in performing measurements directly at birth. By using less cumbersome techniques (and probably more accurate), our previous understanding of the physiological transition at birth is challenged, as well as the causes and consequences for when this transition fails to progress. This review will provide an overview of physiological measurements of the respiratory and hemodynamic transition at birth. Also, it will give a perspective on some of the upcoming technological advances in physiological measurements of neonatal transition in infants who are unable to make the transition without support.

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Section: Pulmonary Transitionmentioning

confidence: 99%

Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

Roest

Siew

et al. 2014

Neonatology

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“…Term and preterm infants begin to breathe after delivery with deep inspirations and braking of expirations (3)(4)(5)(6)(7). Closure of the larynx during expiration may help the newborn to maintain FRC (6,8).…”

mentioning

confidence: 99%

Cerebral Oxygenation in Very Low Birth Weight Infants Supported With Sustained Lung Inflations After Birth

et al. 2011

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Sustained lung inflations (SIs) immediately after birth might decrease the need for subsequent mechanical ventilation in preterm infants. However, effects of SIs on oxygenation and hemodynamics are undetermined. Our aim was to study immediate effects of SIs on heart rate, arterial oxygen saturation, and cerebral tissue oxygen saturation in preterm infants supported with SIs after birth for lung recruitment. Heart rate, arterial oxygen saturation, and cerebral tissue oxygen saturation using near infrared spectroscopy was measured in 24 preterm infants of 28.0 (26.6 -29.3) wk GA [median (interquartile range)] during resuscitation using up to three SIs of 20, 25, and 30 cm H 2 O of 15 s duration each followed by nasal continuous positive airway pressure (CPAP) as first line approach for respiratory support. During positioning and suctioning immediately after delivery infants became progressively hypoxemic and bradycardic before respiratory support was initiated. In 18 infants (75%), more than one SI were applied. During the last SIs, there was a rapid increase in the infants' heart rate and an increase in cerebral tissue oxygen saturation. Arterial saturation increased with slight delay. In conclusion, effective last sustained inflations increase heart rate and cerebral tissue oxygen saturation to be followed by an increase in arterial saturation. (Pediatr Res 70: 176-180, 2011) R eplacement of amniotic fluid by air to establish a gaseous functional residual capacity (FRC) is essential for successful transition after birth (1,2). Term and preterm infants begin to breathe after delivery with deep inspirations and braking of expirations (3-7). Closure of the larynx during expiration may help the newborn to maintain FRC (6,8).Clinical and laboratory observations have shown that the application of continuous positive airway pressure (CPAP) helps to establish a gaseous FRC and improve gas exchange (9 -11). In a preterm animal model, the application of SIs of 10 to 20 s duration did further enhance movement of amniotic fluid into the distal airways resulting in an increased FRC and more uniform lung aeration than CPAP alone (10,12).Clinical studies suggest that the use of SIs in preterm infants may help to reduce the need for intubation and mechanical ventilation without adverse effects (13,14). A lower rate of bronchopulmonary dysplasia (BPD) was reported in one study when SIs followed by nasal CPAP was compared with bag and mask ventilation (13). However, these trials have limited power to prove safety of SIs.Possible sequelae of SIs include overdistension of the lung and compromise of hemodynamics as a result of the impaired systemic venous return and decreased pulmonary blood flow caused by the increase in intrathoracic pressure during the procedure (15-18). Cerebral blood flow may be impaired resulting in brain damage in the preterm infant (19 -21). Impaired cerebral venous flow may predispose to intraventricular hemorrhage (IVH) (22) or periventricular hemorrhagic infarction (23,24).Near-infrared spectros...

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“…In human neonates, V T s of 6.4 (4.1) ml/kg have been observed in term infants and Establishing lung gas volumes at birth Articles 6.7 (3.9) ml/kg in preterm infants, although it is unlikely that the very first breaths after birth were recorded in this study (29). In a separate study of babies receiving continuous positive airway pressure at birth, a variety of different respiratory patterns were observed with V T ranging from mean (SD) 3.1 (1.7) to 7.5 (4.2) ml/kg (30). Although evidence is lacking in preterm human infants, spontaneously breathing newborn rabbits appear to use large V T s (≈15 ml/kg) at the onset of air breathing, which gradually decrease with increasing breath number.…”

Section: Tmentioning

confidence: 69%

“…Although an arbitrary range of 4-8 ml/kg is considered to be the optimal V T range to target when ventilating preterm human infants, a recent study has demonstrated that many of the volumes delivered during resuscitation are inadvertently well outside this range (33). It is clear that some spontaneous breathing infants initiate tidal breathing exceeding 8 ml/kg (29,30). In newborn rabbits, V T reduces as aeration occurs (19).…”

Section: Tmentioning

confidence: 99%

Establishing lung gas volumes at birth: interaction between positive end-expiratory pressures and tidal volumes in preterm rabbits

et al. 2013

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Background:We investigated the effects of positive endexpiratory pressure (PEEP) and tidal volume (V T ) on lung aeration, pulmonary mechanics, and the distribution of ventilation immediately after birth using a preterm rabbit model. Methods: Sixty preterm rabbits (27 d) received volumetargeted positive pressure ventilation from birth, with one of the 12 combinations of PEEP (0, 5, 8, or 10 cmH 2 O) and V T (4, 8, or 12 ml/kg). Outcomes included functional residual capacity (FRC), peak inflating pressure (PIP), dynamic compliance (Cd), and distribution of ventilation. results: Increasing PEEP from 0 to 10 cmH 2 O increased FRC by 4 ml/kg, increased Cd by 0.2 ml/kg/cmH 2 O, and reduced PIP by 5 cmH 2 O. Increasing V T from 4 to 12 ml/kg increased FRC by 2 ml/kg, increased Cd by 0.3 ml/kg/cmH 2 O, and increased PIP by 4 cmH 2 O. No effect of V T on FRC occurred at 0 or 5 PEEP, and no effect of PEEP occurred at V T = 4 ml/kg. At 0 PEEP, increasing V T increased the proportion of gas entering the smaller apical regions, whereas at 10 PEEP, increasing V T increased the proportion of gas entering basal regions, from 47% to 63%. conclusion: Both PEEP and V T have independent, additive effects on FRC, lung mechanics, and the distribution of ventilation during the immediate newborn period.

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Spontaneous Breathing Patterns of Very Preterm Infants Treated With Continuous Positive Airway Pressure at Birth

Cited by 71 publications

References 53 publications

Measuring Physiological Changes during the Transition to Life after Birth

Measuring Physiological Changes during the Transition to Life after Birth

Cerebral Oxygenation in Very Low Birth Weight Infants Supported With Sustained Lung Inflations After Birth

Establishing lung gas volumes at birth: interaction between positive end-expiratory pressures and tidal volumes in preterm rabbits

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