Comparing the effect of two different interfaces on breathing of preterm infants at birth: A matched-pairs analysis

Kuypers, Kristel L A M; Lamberská, Tereza; Martherus, Tessa; Dekker, Janneke; Böhringer, Stefan; Hooper, Stuart B.; Plavka, Richard; Pas, Arjan B. te

doi:10.1016/j.resuscitation.2020.10.004

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…While this study is a case–control study, we used a blinded (to outcome) approach to carefully match CCA affected infants 1:1 with control infants ensuring comparable criteria relevant to breathing effort, using a similar approach as previously described 27 28. In addition, individual patient data were also analysed blinded to the group and so, while not ideal, the risk of bias was minimised as much as possible.…”

Section: Discussionmentioning

confidence: 99%

Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Panneflek

Kuypers

Polglase

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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RationaleAntenatal inflammation, usually associated with chorioamnionitis, is a major cause of premature birth. As inflammation could depress respiratory drive, we have examined the effect of clinical chorioamnionitis (CCA) on spontaneous breathing in premature infants at birth.MethodsInfants with CCA born <30 weeks’ gestation were matched with control infants based on gestational age (±6 days), birth weight (±300 g), antenatal corticosteroids, sex and general anaesthesia. The primary outcome was breathing effort, assessed as minute volume (MV) of spontaneous breathing. We also measured tidal volume (Vt), respiratory rate (RR) and apnoea in the first 5 min and additional physiological parameters in the first 10 min after start of respiratory support.ResultsNinety-two infants were included (n=46 CCA infants vs n=46 controls; median (IQR) gestational age 26+4(25+0–27+6) vs 26+6(25+1–28+3) weeks). MV and Vt were significantly lower (MV: 43 (17–93) vs 70 (31–119) mL/kg/min, p=0.043; Vt: 2.6 (1.9–3.6) vs 2.9 (2.2–4.8) mL/kg/breath, p=0.046), whereas RR was similar in CCA infants compared with controls. Incidence of apnoea was higher (5 (2-6) vs 2 (1-4), p=0.002), and total duration of apnoea was longer (90 (21-139) vs 35 (12-98) s, p=0.025) in CCA infants. CCA infants took significantly longer to reach an oxygen saturation >80% (3:37 (2:10–4:29) vs 2:25 (1:06–3:52) min, p=0.016) and had a lower oxygen saturation at 5 min (77 (66–92) vs 91 (68–94) %, p=0.028), despite receiving more oxygen (62 (48-76) vs 54 (43-73) %, p=0.036).ConclusionCCA is associated with reduced breathing effort and oxygenation in premature infants at birth.

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Section: Discussionmentioning

confidence: 99%

Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Panneflek

Kuypers

Polglase

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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“…Applying bi-nasal prongs compared to a face mask for initial respiratory support did not result in a different incidence of apnoea among ELBW infants. However, the apnoea incidence was rather high for both interfaces (43/65 (66%) versus 46/65 (71%), p = 0.70) [61,62].…”

Section: Initial Respiratory Supportmentioning

confidence: 86%

Delivery Room Care for Premature Infants Born after Less than 25 Weeks’ Gestation—A Narrative Review

2021

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Premature infants born after less than 25 weeks’ gestation are particularly vulnerable at birth and stabilization in the delivery room (DR) is challenging. After birth, infants born after <25 weeks’ gestation develop respiratory and hemodynamic instability due to their immature physiology and anatomy. Successful stabilization at birth has the potential to reduce morbidities and mortalities, while suboptimal DR care could increase long-term sequelae. This article reviews current neonatal resuscitation guidelines and addresses challenges during DR stabilization in extremely premature infants born after <25 weeks’ gestation at the threshold of viability.

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“…A recent retrospective matched-pairs study that compared the use of binasal prongs and FM for resuscitation in preterm infants < 32 weeks found no difference in the rate of occurrence of apnea and bradycardia. The authors of this study hypothesize that binasal prongs could still trigger the TCR by stimulating the trigeminal receptors inside the nose or over the maxillary region (V2) [10]. A meta-analysis including five RCTs conducted over a 12-year period compared the nasal prongs or nasopharyngeal tube with FM for delivery room resuscitation in infants born < 37 weeks.…”

Section: Introductionmentioning

confidence: 99%

Laryngeal Masks in Neonatal Resuscitation—A Narrative Review of Updates 2022

2022

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Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced resuscitation such as intubation, chest compression, and epinephrine. Every 30 s delay in initiation of PPV increased the risk of death or morbidity by 16%. The most effective interface for providing PPV in the early phases of resuscitation is still unclear. Laryngeal masks (LMs) are supraglottic airway devices that provide less invasive and relatively stable airway access without the need for laryngoscopy which have been studied as an alternative to face masks and endotracheal tubes in the initial stages of neonatal resuscitation. A meta-analysis found that LM is a safe and more effective alternative to face mask ventilation in neonatal resuscitation. LM is recommended as an alternative secondary airway device for the resuscitation of infants > 34 weeks by the International Liaison Committee on Resuscitation. It is adopted by various national neonatal resuscitation guidelines across the globe. Recent good-quality randomized trials have enhanced our understanding of the utility of laryngeal masks in low-resource settings. Nevertheless, LM is underutilized due to its variable availability in delivery rooms, providers’ limited experience, insufficient training, preference for endotracheal tube, and lack of awareness.

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Comparing the effect of two different interfaces on breathing of preterm infants at birth: A matched-pairs analysis

Cited by 8 publications

References 14 publications

Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Delivery Room Care for Premature Infants Born after Less than 25 Weeks’ Gestation—A Narrative Review

Laryngeal Masks in Neonatal Resuscitation—A Narrative Review of Updates 2022

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