Continuous Positive Airway Pressure and the Burden of Care for Transient Tachypnea of the Neonate: Retrospective Cohort Study

Gizzi, Camilla; Klifa, Roman; Pattumelli, Maria Grazia; Massenzi, Luca; Taveira, Mélanie; Shankar-Aguilera, Shivani; Luca, Danièle De

doi:10.1055/s-0034-1543988

Cited by 33 publications

(23 citation statements)

References 21 publications

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“…Interestingly, the finding that supplemental oxygen does not further reduce the associated morbidity in infants receiving CPAP (8) indicates that oxygenation exchange per se is not the problem. Instead, a limitation on effectively moving gas into and out of the lung is the likely cause.…”

Section: Discussionmentioning

confidence: 99%

Elevated airway liquid volumes at birth: a potential cause of transient tachypnea of the newborn

McGillick

Lee

Yamaoka

et al. 2017

Journal of Applied Physiology

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Excessive liquid in airways and/or distal lung tissue may underpin the respiratory morbidity associated with transient tachypnea of the newborn (TTN). However, its effects on lung aeration and respiratory function following birth are unknown. We investigated the effect of elevated airway liquid volumes on newborn respiratory function. Near-term rabbit kittens (30 days gestation; term ~32 days) were delivered, had their lung liquid-drained, and either had no liquid replaced (control; = 7) or 30 ml/kg of liquid re-added to the airways [liquid added (LA); = 7]. Kittens were mechanically ventilated in a plethysmograph. Measures of chest and lung parameters, uniformity of lung aeration, and airway size were analyzed using phase contrast X-ray imaging. The maximum peak inflation pressure required to recruit a tidal volume of 8 ml/kg was significantly greater in LA compared with control kittens (35.0 ± 0.7 vs. 26.8 ± 0.4 cmHO, < 0.001). LA kittens required greater time to achieve lung aeration (106 ± 14 vs. 60 ± 6 inflations, = 0.03) and had expanded chest walls, as evidenced by an increased total chest area (32 ± 9%, < 0.0001), lung height (17 ± 6%, = 0.02), and curvature of the diaphragm (19 ± 8%, = 0.04). LA kittens had lower functional residual capacity during stepwise changes in positive end-expiratory pressures (5, 3, 0, and 5 cmH0). Elevated lung liquid volumes had marked adverse effects on lung structure and function in the immediate neonatal period and reduced the ability of the lung to aerate efficiently. We speculate that elevated airway liquid volumes may underlie the initial morbidity in near-term babies with TTN after birth. Transient tachypnea of the newborn reduces respiratory function in newborns and is thought to result due to elevated airway liquid volumes following birth. However, the effect of elevated airway liquid volumes on neonatal respiratory function is unknown. Using phase contrast X-ray imaging, we show that elevated airway liquid volumes have adverse effects on lung structure and function in the immediate newborn period, which may underlie the pathology of TTN in near-term babies after birth.

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Section: Discussionmentioning

confidence: 99%

Elevated airway liquid volumes at birth: a potential cause of transient tachypnea of the newborn

McGillick

Lee

Yamaoka

et al. 2017

Journal of Applied Physiology

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“…Appropriately sized nasal prongs or masks were used together with pacifiers of adequate size with drops of 30% glucose solution to reduce leaks and provide sedation. CPAP was set at 4 cm H 2 O and increased to 6 cm H 2 O if needed, according to the severity of respiratory distress; supplemental oxygen was added to keep the peripheral oxygen saturation between 90 and 95%, when CPAP was not sufficient to achieve this [12]. Initial fluid intake was ≤60 mL/kg/day.…”

Section: Methodsmentioning

confidence: 99%

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

Raimondi

Yousef

Fanjul³

et al. 2019

Neonatology

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Background and Aim: Discordant results that demand clarification have been published on diagnostic lung ultrasound (LUS) signs of transient tachypnea of the neonate (TTN) in previous cross-sectional, single-center studies. This work was conducted to correlate clinical and imaging data in a longitudinal and multicenter fashion. Methods: Neonates with a gestational age of 34–40 weeks and presenting with TTN underwent a first LUS scan at 60–180 min of life. LUS scans were repeated every 6–12 h if signs of respiratory distress persisted. Images were qualitatively described and a LUS aeration score was calculated. Clinical data were collected during respiratory distress. Results: We enrolled 65 TTN patients. Thirty-one (47.6%) had a sharp echogenicity increase in the lower lung fields (the “double lung point” or DLP sign). On admission, there was no significant difference between patients with and without DLP in Silverman scores (4 ± 1.5 vs. 4 ± 2.1; p = 0.9) or LUS scores (7.6 ± 2.6 vs. 5.6 ± 3.8; p = 0.12); PaO₂/FiO₂ (249 ± 93 vs. 252 ± 125; p = 0.91). All initial LUS scans (performed at the onset of distress) and 99.5% of all scans showed a regular pleural line with no consolidation, with only 1 neonate showing consolidation in the follow-up scans. The Silverman and LUS scores were significantly correlated (rho = 0.27; p = 0.02). Conclusion: A regular pleural line with no consolidation is a consistent finding in TTN. The presence of a DLP is not essential for the LUS diagnosis of TTN. A semi-quantitative LUS score correlates well with the clinical course and could be useful in monitoring changes in lung aeration during TTN.

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“…CPAP was set at 6 cm H 2 O, and Fio 2 levels were adjusted to maintain oxygen saturation levels within the 90% to 95% target range, while pacifiers of adequate size with drops of 30% glucose solution were used to reduce leaks and provide sedation, if needed. 9,17 We administered 200 mg/kg of poractant α (Curosurf; Chiesi Farmaceutici, Parma, Italy) through the intubation-surfactant-extubation technique if the Fio 2 was >0.3 or >0.4 for infants ≤28 and >28 weeks' GA, respectively; these thresholds have been modified from those suggested by European guidelines. 1 A second 100 mg/kg dose was given if the Fio 2 remained higher than the cutoff Fio 2 value ≥10 hours after the first administration.…”

Section: Patientsmentioning

confidence: 99%

Lung Ultrasound Score Predicts Surfactant Need in Extremely Preterm Neonates

et al. 2018

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Continuous Positive Airway Pressure and the Burden of Care for Transient Tachypnea of the Neonate: Retrospective Cohort Study

Abstract: CPAP seems a useful therapeutics for TTN, as it may reduce the burden of care without increasing air leaks or patients' discomfort.

Cited by 33 publications

References 21 publications

Elevated airway liquid volumes at birth: a potential cause of transient tachypnea of the newborn

Elevated airway liquid volumes at birth: a potential cause of transient tachypnea of the newborn

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

Lung Ultrasound Score Predicts Surfactant Need in Extremely Preterm Neonates

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