Effects of Multiple Ventilation Courses and Duration of Mechanical Ventilation on Respiratory Outcomes in Extremely Low-Birth-Weight Infants

Jensen, Erik A.; DeMauro, Sara B.; Kornhauser, Michael; Aghai, Zubair H.; Greenspan, Jay S.; Dysart, Kevin

doi:10.1001/jamapediatrics.2015.2401

Cited by 161 publications

(139 citation statements)

References 31 publications

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“…2 Since the longer duration of mechanical ventilation and oxygen supplementation can induce lung damage and lead to BPD, the recent recommended strategies in premature infants' lung care are a lower duration and more synchronized type of mechanical ventilation and proper timing and concentration of oxygen supply. 35,36 In our study, t PEF /t E was well correlated with the duration of mechanical ventilation and oxygen supplementation, which also supports the notion that t PEF /t E could be a useful pulmonary index in severe BPD.…”

Section: Discussionsupporting

confidence: 86%

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Kim

Eun

et al. 2019

Pediatric Pulmonology

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Objectives To determine significant indices for assessing the pulmonary function of infants according to bronchopulmonary dysplasia (BPD) severity and to evaluate whether small for gestational age (SGA) could affect pulmonary function in BPD. Methods We evaluated 117 preterm infants who had undergone tidal breathing flow‐volume loop and multiple‐breath washout analyses within 7 months after birth. We categorized preterm infants according to BPD severity into mild/moderate BPD (n = 86), severe BPD (n = 21), and without BPD (n = 10) and the presence of SGA or appropriate gestational age (AGA) using the Fenton growth chart. We evaluated nine healthy term infants as controls. Results The tidal breathing ratio (time to peak expiratory flow/expiratory time [tPEF/tE]) was significantly lower in infants with severe BPD than in those with mild/moderate BPD. Lung clearance index (LCI) was not different based on BPD severity. In the correlation analysis after adjusting for gestational age and sex, tPEF/tE was correlated with the duration of mechanical ventilation (r = −0.347, P < .001) and the duration of oxygen supply (r = −0.248, P = .013) in infants with BPD. The proportion of “lower tPEF/tE,” defined as below the cut‐off value, was greater in SGA infants (P = .017), while no significant difference was seen in the percentage of “higher LCI,” defined as above the cut‐off value between SGA and AGA infants. Conclusions In infants with BPD, tPEF/tE could be a useful pulmonary index which shows lower values in severe BPD. The finding of SGA in infants with BPD could be associated with poor pulmonary function related to the tPEF/tE values.

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Section: Discussionsupporting

confidence: 86%

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Kim

Eun

et al. 2019

Pediatric Pulmonology

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“…Endotracheal ventilation has been associated with lung trauma and subsequent BPD, especially if longer cumulative duration of mechanical ventilation is provided [23]. Several reports highlight the importance of different strategies in reducing lung damage, i.e., initial nasal continuous positive airway pressure assistance for preterm infants with RDS, early extubation, and gentler ventilation [24,25].…”

Section: Discussionmentioning

confidence: 99%

New Insights on Early Patterns of Respiratory Disease among Extremely Low Gestational Age Newborns

et al. 2017

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Background: The analysis of early patterns of lung disease among preterm infants may help to identify predictors of pulmonary deterioration. Objectives: To analyze FIO₂ requirement in the first 14 days of life among preterm infants and to find predictors of bronchopulmonary dysplasia (BPD). Methods: Retrospective cohort study. Setting: 3 Italian level III NICUs. Population: infants born between 24^0/7 and 27^6/7 weeks' gestational age (GA) who survived to 14 days. A consecutive sample of 588 infants was analyzed. Daily mode FIO₂ in the first 2 weeks of life were analyzed according to the criteria defined by Laughon et al. [Pediatrics 2009;123:1124-1131], who found 3 early respiratory patterns: consistently low FIO₂ (LowFIO₂), pulmonary deterioration (PD), and early persistent pulmonary deterioration (EPPD). Factors associated with pulmonary deterioration were studied by univariate and multivariate analysis. Results: Forty percent of infants had low FIO₂, 18% had pulmonary deterioation, 21% had early persistent pulmonary deterioration, and 21% had a previously unreported pattern (pulmonary improvement, PI). The prevalence of BPD was 7% in the LowFIO₂ group, 28% in the PI group, 44% in the PD group, and 62% in the EPPD group (p = 0.000). Infants with lung deterioration were more frequently males (OR = 2.019, CI: 1.319-3.090, p = 0.001), had lower GA (OR = 0.945, CI: 0.915-0.975, p = 0.000), higher incidence of severe respiratory distress syndrome (OR = 2.956, CI: 1.430-6.112, p = 0.003), and lack of postnatal caffeine (OR = 0.167, CI: 0.052-0.541, p = 0.003). Conclusions: We report 4 distinct patterns of early respiratory disease associated with significantly different prevalence of BPD and discuss risk factors for lung deterioration.

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“…Recently, we have shown that cumulative days of ventilatory support and 4 or more ventilator courses are associated with BPD and respiratory morbidities in ELBW infants. 21 Another possibility for prolonged respiratory support with the use of HFNC is that caregivers perceive HFNC to be “low risk” and are slower to wean or stop it. Yoder et al 15 reported that infants managed on HFNC require prolonged noninvasive respiratory support.…”

Section: Discussionmentioning

confidence: 99%

High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants

Taha

Kornhauser

Greenspan

et al. 2016

The Journal of Pediatrics

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Objective To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP). Study design This is aretrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤ 1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis. Results A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P < .05). Similarly, adjusted odds of developing BPD or death was greater in the HFNC ± CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035–1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group. Conclusions In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants.

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Effects of Multiple Ventilation Courses and Duration of Mechanical Ventilation on Respiratory Outcomes in Extremely Low-Birth-Weight Infants

Cited by 161 publications

References 31 publications

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

New Insights on Early Patterns of Respiratory Disease among Extremely Low Gestational Age Newborns

High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants

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