The Breathing Effort of Very Preterm Infants at Birth

Huberts, Tom J. P.; Foglia, Elizabeth E.; Narayen, Ilona C.; Vonderen, Jeroen J van; Hooper, Stuart B.; Pas, Arjan B. te

doi:10.1016/j.jpeds.2017.11.008

Cited by 16 publications

(11 citation statements)

References 24 publications

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“…Schilleman et al [19] reported that breathing was often not observed, resulting in spontaneous breathing during and in between inflations given. More recently, Huberts et al [20] measured respiratory effort at birth and observed that very preterm infants indeed breathe when receiving mask ventilation, but the respiratory effort was significantly lower when compared with infants who received CPAP. Thus, the reduced breathing effort observed likely justifies applying mask ventilation in most infants.…”

Section: The Larynxmentioning

confidence: 99%

The Changing Landscape in Supporting Preterm Infants at Birth

2019

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Noninvasive ventilation for preterm infants at birth has been recommended and universally adopted. The umbilical cord is often clamped immediately in order to provide the support the infant needs for stabilization. However, recent scientific data from experimental studies that involve animals in transition and human studies using physiological measurements at birth have increased awareness as to how little we know about how these interventions interact and integrate with the infant’s changing physiology. It has become clear that in apneic infants the larynx is closed immediately after birth, which can completely negate the effect of noninvasive ventilation of the lung. For this reason, stimulating and supporting spontaneous breathing could enhance the success of noninvasive ventilation. Animal data also demonstrated that the large swings in blood pressure, blood flow, and oxygenation caused by immediate cord clamping can be avoided by postponing cord clamping until lung aeration has been established. In this review we will focus on these “game changers” that have the potential to completely change the approach used in stabilizing preterm infants at birth.

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Section: The Larynxmentioning

confidence: 99%

The Changing Landscape in Supporting Preterm Infants at Birth

2019

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“…Most preterm infants breathe at birth, but the effort is often insufficient to clear the lung liquid and to aerate the lung in an adequate manner. [24] The caregiver should be aware that breathing can be subtle and is often missed while positive pressure is applied. Because we now use a lower oxygen concentration in order to avoid hyperoxia, hypoxia may occur in the first minutes after birth,[25,26] and this should also be avoided as it negatively influences the breathing effort.…”

Section: The Physiology Of Newborn Transition and How This Alters Durmentioning

confidence: 99%

Effective ventilation: The most critical intervention for successful delivery room resuscitation

Foglia

Pas

2018

Seminars in Fetal and Neonatal Medicine

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Lung aeration is the critical first step that triggers the transition from fetal to postnatal cardiopulmonary physiology after birth. When an infant is apneic or does not breathe sufficiently, intervention is needed to support this transition. Effective ventilation is therefore the cornerstone of neonatal resuscitation. In this article, we review the physiology of cardiopulmonary transition at birth, with particular attention to factors the caregiver should consider when providing ventilation. We then summarize the available clinical evidence for strategies to monitor and perform positive pressure ventilation in the delivery room setting.

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“… 32 33 Most preterm infants start breathing within the first minute of life, but the effort is most often not efficient enough to establish lung aeration. 34 Measuring tidal volumes during spontaneous breathing and positive pressure ventilation using a respiratory function monitor might help the clinician to assess the infant’s condition. 35 36 Also, measuring expired CO 2 can provide additional information about alveolar ventilation and the presence of pulmonary gas exchange in the newborn lung, rather than ventilation of dead space.…”

Section: Practical Considerationsmentioning

confidence: 99%

Clinical aspects of incorporating cord clamping into stabilisation of preterm infants

Knol¹,

Brouwer

Vernooij

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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Fetal to neonatal transition is characterised by major pulmonary and haemodynamic changes occurring in a short period of time. In the international neonatal resuscitation guidelines, comprehensive recommendations are available on supporting pulmonary transition and delaying clamping of the cord in preterm infants. Recent experimental studies demonstrated that the pulmonary and haemodynamic transition are intimately linked, could influence each other and that the timing of umbilical cord clamping should be incorporated into the respiratory stabilisation. We reviewed the current knowledge on how to incorporate cord clamping into stabilisation of preterm infants and the physiological-based cord clamping (PBCC) approach, with the infant’s transitional status as key determinant of timing of cord clamping. This approach could result in optimal timing of cord clamping and has the potential to reduce major morbidities and mortality in preterm infants.

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The Breathing Effort of Very Preterm Infants at Birth

Cited by 16 publications

References 24 publications

The Changing Landscape in Supporting Preterm Infants at Birth

The Changing Landscape in Supporting Preterm Infants at Birth

Effective ventilation: The most critical intervention for successful delivery room resuscitation

Clinical aspects of incorporating cord clamping into stabilisation of preterm infants

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