Noninvasive Respiratory Support

Polin, Richard A.; Watterberg, Kristi L.; Cummings, James J.; Benitz, William Ε.; Eichenwald, Eric C.; Poindexter, Brenda B.; Stewart, Dan L.; Aucott, Susan W.; Goldsmith, Jay P.; Puopolo, Karen M.; Wang, Kasper S.

doi:10.1542/peds.2015-3758

Cited by 87 publications

(53 citation statements)

References 86 publications

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“…The decrease risk of BPD in the early caffeine group may be due to infants receiving earlier extubation and shorter duration of mechanical ventilation. Several reviews have shown that the use of non-invasive respiratory support decreases the need for invasive mechanical ventilation and the combined Systematic review of early caffeine therapy in preterm neonates outcome of death or BPD [34,35]. Our review found similar findings, with a lower percentage of infants in the early caffeine group required mechanical ventilation (RR: 0.98; 95% CI: 0.96-1.00) and shorter duration of mechanical ventilation (absolute mean difference: 7.50 days shorter in early caffeine group, P < 0.001), which could lead to improvements in chronic respiratory and neurological outcomes in the premature neonates.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta‐analysis of clinical outcomes of early caffeine therapy in preterm neonates

Kua

Lee

2016

Brit J Clinical Pharma

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AIMSThis study evaluated the therapeutic outcomes of early versus late caffeine therapy in preterm neonates. METHODSWe performed a systematic literature search in PubMed, Embase, CINAHL and CENTRAL from inception to 30 June 2016 to identify studies investigating the use of early caffeine therapy (initiated at less than 3 days of life) in preterm infants. Effect estimates were combined using random-effects meta-analysis. The primary outcomes for this study were bronchopulmonary dysplasia and mortality. RESULTSThe initial search found 4066 citations, of which 14 studies enrolling a total of 64 438 participants were included. The time of initiation of early caffeine therapy varied from the first 2 h to 3 days postnatal. Early caffeine therapy reduced the risk of bronchopulmonary dysplasia in both cohort studies (RR: 0.80, 95% CI: 0.66 to 0.96) and randomized controlled trials (RR: 0.67, 95% CI: 0.56 to 0.81). In cohort studies, neonates treated early with caffeine also showed decreased risks of patent ductus arteriosus, brain injury, retinopathy of prematurity and postnatal steroid use. However, the mortality rate was increased. CONCLUSIONSThe findings suggest that early caffeine therapy is associated with reduced incidence of bronchopulmonary dysplasia and may help decrease the burden of morbidities in preterm infants. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Caffeine therapy is commonly used to treat apnoea of prematurity and facilitate extubation in neonates. It is shown to reduce the rates of bronchopulmonary dysplasia, severe retinopathy of prematurity, cerebral palsy and cognitive delay.• Recent publications suggests that early initiation of caffeine may have incremental benefits on neonatal outcomes. British Journal of Clinical Pharmacology WHAT THIS STUDY ADDS• This systematic review found that early caffeine therapy (initiated <3 days of life) was associated with a significant reduction in the incidence of bronchopulmonary dysplasia compared with late caffeine therapy. Tables of Links

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Section: Discussionmentioning

confidence: 99%

Systematic review and meta‐analysis of clinical outcomes of early caffeine therapy in preterm neonates

Kua

Lee

2016

Brit J Clinical Pharma

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“…We found no difference in the breathing effort and concluded that HFNC could replace nCPAP when preterm infants are ready for weaning. safety, efficacy, short-term and long-term outcomes of this method (7,(11)(12)(13).…”

Section: Key Notesmentioning

confidence: 99%

“…HFNC is also considered easy to administer and comfortable for the infant. However, there are still unanswered questions regarding the safety, efficacy, short‐term and long‐term outcomes of this method .…”

Section: Introductionmentioning

confidence: 99%

A randomised cross‐over study showed no difference in diaphragm activity during weaning from respiratory support

et al. 2018

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“…However, Ovalle et al reported that 30% of infants who received a HHHFNC after InSurE required reintubation, leading the authors to suggest that a HHHFNC could be comparable to nCPAP to prevent reintubation in patients treated with InSurE. Further randomized controlled trials are needed3334).…”

Section: Efficacy Of Hfnc Compared To Other Niv Modesmentioning

confidence: 99%

Respiratory support with heated humidified high flow nasal cannula in preterm infants

Jeon

2016

Korean J Pediatr

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The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes. A number of studies have shown that nasal breakdown and neonatal complications were lower when using a HHHFNC than when using nasal continuous positive airway pressure (nCPAP), or nasal intermittent positive pressure ventilation. The rates of extubation failure during respiratory support were not different between patients who used HHHFNC and nCPAP. However, data from the use of HHHFNC as the initial respiratory support "after birth", particularly in extremely preterm infants, are lacking. Although the HHHFNC is efficacious and safe, large randomized controlled trials are needed before the HHHFNC can be considered an NIV standard, particularly for extremely preterm infants.

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Noninvasive Respiratory Support

Cited by 87 publications

References 86 publications

Systematic review and meta‐analysis of clinical outcomes of early caffeine therapy in preterm neonates

Systematic review and meta‐analysis of clinical outcomes of early caffeine therapy in preterm neonates

A randomised cross‐over study showed no difference in diaphragm activity during weaning from respiratory support

Respiratory support with heated humidified high flow nasal cannula in preterm infants

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