One Step Further Toward Defining the Optimal Respiratory Care Package for Neonates

Zivanovic, Sanja; Roehr, Charles Christoph

doi:10.1001/jamapediatrics.2016.3271

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Thus, the multifactorial pathogenesis of BPD remains a challenge in the management of preterm infants. Identifying appropriate composite measures to avoid the development of neonatal lung disease, which include avoiding mechanical ventilation, targeted and timely surfactant replacement and optimised caffeine therapy, will add to creating an individualised respiratory care packages in the future …”

Section: Discussionmentioning

confidence: 99%

Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

et al. 2019

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Aim To investigate interinstitutional differences in preterm infant stabilisation between two European tertiary neonatal centres with particular focus on intubation timing, surfactant administration, caffeine therapy and neonatal morbidity and mortality. Methods Retrospective (2012‐2014) study of very low birth weight (VLBW) preterm infants admitted to John Radcliffe Hospital (UK centre) and Charité Medical Centre (German centre). Timing of intubation, surfactant and caffeine administration and respiratory outcomes were examined. Results Gestational age, birth weight and five‐minute Apgar scores of VLBW infants from the UK centre (n = 86) were comparable to those from the German centre (n = 96). Significant differences in antenatal steroid therapy, intubation timing and surfactant therapy were noted. Timing of caffeine initiation differed significantly between centres (median 0 [0‐2.5] UK vs. 2 [1.5‐4] days German centre); however, caffeine was discontinued at a similar corrected gestational age of 34.7 weeks. Mechanical ventilation was significantly longer at the UK centre, but there was no difference in bronchopulmonary dysplasia (BPD) (44% UK vs. 36% German centre) or mortality (15% UK vs. 13% German centre). Conclusion Timing of primary intubation and caffeine therapy differed significantly between centres. However, earlier intubation and caffeine administration in the UK centre were not associated with a changed incidence of BPD.

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Section: Discussionmentioning

confidence: 99%

Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

et al. 2019

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“…These preventive measures include, but are not limited to: less use of invasive mechanical ventilation and predominant use of non-invasive respiratory support strategies, minimally invasive surfactant application, avoidance of hyper-and hypoxia, caffeine, corticosteroids, and reduction of infections. [63][64][65][66] Further research is required to determine the role of caffeine and corticosteroids on the developing pulmonary vasculature. The same is true for a possible contribution of a hemodynamically significant PDA (here: sole left-to-right shut) to PH and PVD in BPD infants.…”

Section: Prevention Of Bpd-phmentioning

confidence: 99%

Pulmonary hypertension in bronchopulmonary dysplasia

et al. 2020

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Bronchopulmonary dysplasia (BPD) is a major complication in prematurely born infants. Pulmonary hypertension (PH) associated with BPD (BPD-PH) is characterized by alveolar diffusion impairment, abnormal vascular remodeling, and rarefication of pulmonary vessels (vascular growth arrest), which lead to increased pulmonary vascular resistance and right heart failure. About 25% of infants with moderate to severe BPD develop BPD-PH that is associated with high morbidity and mortality. The recent evolution of broader PH-targeted pharmacotherapy in adults has opened up new treatment options for infants with BPD-PH. Sildenafil became the mainstay of contemporary BPD-PH therapy. Additional medications, such as endothelin receptor antagonists and prostacyclin analogs/mimetics, are increasingly being investigated in infants with PH. However, pediatric data from prospective or randomized controlled trials are still sparse. We discuss comprehensive diagnostic and therapeutic strategies for BPD-PH and briefly review the relevant differential diagnoses of parenchymal and interstitial developmental lung diseases. In addition, we provide a practical framework for the management of children with BPD-PH, incorporating the modified definition and classification of pediatric PH from the 2018 World Symposium on Pulmonary Hypertension, and the 2019 EPPVDN consensus recommendations on established and newly developed therapeutic strategies. Finally, current gaps of knowledge and future research directions are discussed.

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“…Given today's cohort of extremely preterm, often periviable infants, the development of gestational age-specific optimal care seems inevitable. 32 The Benefit of Early and Liberal CPAP: Applicable to the Very Tiny Baby?…”

Section: Bpdmentioning

confidence: 99%

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Wright

Glaser

Speer

et al. 2022

The Journal of Pediatrics

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One Step Further Toward Defining the Optimal Respiratory Care Package for Neonates

Abstract: Administration of antibiotics to children before age 2 years increases risk for childhood obesity.

Cited by 6 publications

References 15 publications

Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

Pulmonary hypertension in bronchopulmonary dysplasia

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

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