Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasia

Abstract

The Scandinavian approach is an effective combined treatment for respiratory distress syndrome (RDS) and prevention of bronchopulmonary dysplasia (BPD). It is composed of many individual parts.Of significant importance is the early treatment with nasal continuous positive airway pressure (nCPAP) and surfactant treatment. The approach may be supplemented with caffeine citrate and non-invasive positive pressure ventilation for apnoea. The low incidence of BPD seen as a consequence of the treatment strategy is mainly due to a reduced need for mechanical ventilation (MV).Conclusion: Early-postnatal treatment with nCPAP and surfactant decreases the severity and mortality of RDS and BPD. This is mainly due to a diminished use of MV in the first days of life.

High-Frequency Oscillatory Ventilation Versus Synchronized Intermittent Mandatory Ventilation Plus Pressure Support in Preterm Infants With Severe Respiratory Distress Syndrome

“…1 Respiratory distress syndrome (RDS) is common in preterm infants born at Ͻ 32 weeks of gestational age, [2][3][4] and surfactant and mechanical ventilation have been the standard treatment. 5 However, despite advances in neonatal respiratory care, a considerable number of preterm infants develop chronic lung disease, termed bronchopulmonary dysplasia (BPD), [5][6][7][8] that is associated with neonatal death, prolonged NICU stay, and impaired neurodevelopment. 9 BPD has a multifactorial pathogenesis, and invasive mechanical ventilation is one of its most important causes.…”

Nasal CPAP vs. mechanical ventilation in 28-32 weeks preterm infants with early surfactant administration

“…Estos resultados se unen a los de muchas otras series citadas en la literatura científica, en las que se ha encontrado que la CPAP disminuye la incidencia de displasia broncopulmonar (3,4,(6)(7)(8)18,19,21,24,32,33). En otros estudios no se han encontrado diferencias en la incidencia de la displasia broncopulmonar, pero en ninguno de ellos se empleó la misma intervención evaluada en el presente estudio.…”

“…En los metaanálisis publicados en los últimos años, que incluyen gran cantidad de estudios sobre intervenciones sin uso de surfactante, se concluye que: la CPAP reduce el tiempo de intervención de la enfermedad de membrana hialina; que es equivalente a la respiración mecánica en cuanto a mortalidad, presencia de enterocolitis necrosante y hemorragia intraventricular (con la ventaja de que puede usarse incluso en prematuros muy pequeños), y que la gravedad de la displasia broncopulmonar es menor, por lo que también se reduce el uso de oxígeno y esteroides (1,2,(4)(5)(6)(7)(8).…”

“…Sin embargo, los ensayos clínicos y metaanálisis publicados hasta el momento no incluyen el efecto que tiene la aplicación de surfactante pulmonar en los resultados cuando se comparan la CPAP y la respiración mecánica asistida. Se encuentran estudios en los que se compara la CPAP sin administración de surfactante y la respiración mecánica asistida con surfactante, pero no así estudios que comparen estas dos estrategias empleadas con surfactante, por lo que existe la necesidad de llevarlos a cabo (2,(4)(5)(6)(7)(8), objetivo al que se abocó el presente estudio de cohorte.…”

How can we minimize barotraumas in our most premature infants?

“…11 Thus, the incidence of BPD was very low in centers that introduced INSURE compared with centers using MV and rescue surfactant. 12 An US group reduced the incidence of chronic lung disease in infants with birth weight <1500 g by avoiding intubation in the delivery room, adoption of new pulse oximeter limits and very early use of NCPAP and surfactant, 13 and in a randomized study comparing INSURE with NCPAP, the incidence of BPD, MV and air leaks was less in the INSURE group. 7 In studies using primary MV, the incidence of BPD was lower following prophylactic surfactant than after rescue treatment with surfactant, 14 and early selective surfactant treatment reduced the combined mortality and BPD more effectively than the rescue treatment.…”