No abstract

BackgroundInhaled nitric oxide (iNO) has been used as a rescue treatment for preterm infants with hypoxemic respiratory failure (HRF). However, its effectiveness remains debatable. Thus, in this study, we aimed to examine the impact of iNO therapy on HRF in extremely preterm infants.MethodsA retrospective observational study was performed. Extremely preterm infants admitted to our neonatal intensive care unit who received iNO therapy later in their postnatal life were included. The oxygen saturation index (OSI) was used as an index of the severity of respiratory failure.ResultsIn total, 30 extremely preterm infants were included in this study. Oxygenation was enhanced after the administration of iNO in infants with HRF. The OSI decreased by more than 20% in 12 patients (40%, positive responder) and did not decrease in 17 patients (57%, negative responder) within the first 6 h of treatment. The iNO initiation day was the significant independent factor associated with a positive response to iNO therapy in extremely preterm infants with HRF.ConclusionsiNO therapy was effective in enhancing oxygenation in extremely preterm infants with HRF. Earlier use of iNO was the significant factor associated with a positive therapeutic response to iNO, implying that iNO may be more effective in pulmonary vessels which are less damaged by shorter‐term mechanical ventilation.

No abstract

Non-invasive neurally-adjusted ventilatory assist (NIV-NAVA) improves patient-ventilator synchrony and reduces treatment failure in preterm infants compared with nasal continuous positive airway pressure (NCPAP) and non-invasive positive-pressure ventilation (NIPPV). We conducted a systematic review and meta-analysis to assess the effectiveness of NIV-NAVA in preterm infants with respiratory distress. Four investigators independently assessed the eligibility of studies in CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PubMed, and WHO ICTRP databases, and extracted data. The included studies were randomized controlled trials (RCTs) comparing NIV-NAVA with other non-invasive ventilation modalities in preterm infants. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and four RCTs which examined 259 preterm infants were eligible to this study. In the subgroup of secondary use after extubation, NIV-NAVA reduces the risk of treatment failure compared with NCPAP/NIPPV (risk ratio 0.29; 95% confidence interval [0.10, 0.81], 2 RCTs, 96 infants, low certainty of the evidence). In the subgroup of primary use at birth, no statistically significant differences in treatment failure were observed (very low certainty of the evidence). Moreover, there were no significant differences in secondary outcomes. Therefore, NIV-NAVA may prevent treatment failure and the requirement of reintubation in preterm infants.