Preterm VLBW infants: post-extubation respiratory support

Gilmore, Maureen

doi:10.1038/sj.jp.7211542

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Two major concerns still exist preventing the universal acceptance of the VT HFNC in the NICU: (1) the inability to measure the CPAP generated by VT, (2) the potential for infection. 16,17 The unmeasured CPAP effect is a safety concern with the potential risk of lung over inflation, a known risk factor for BPD, as well as a cause of increased work of breathing. The potential for pneumothoraces is also a concern.…”

Section: Discussionmentioning

confidence: 99%

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Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol

2007

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Objective: Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) are frequent complications of prematurity. To decrease ventilator-induced lung injury, we evaluated the safety, efficacy and neonatal outcomes of a heated humidified high-flow nasal cannula (HFNC) system and an early extubation protocol (EEP) designed for preterm infants 25 to 29 weeks' gestational age (GA). Result: Inclusion criteria were met by 49/57 infants in the control group and 65/75 infants in the HFNC group. The groups had similar demographics, perinatal conditions, birthweight, GA, timing and total doses of surfactant. There were no differences in rates of extubation failure, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, laser eye surgery, sepsis, BPD at 28 days and 36 weeks and death. The groups did not differ in oxygen use, i.v. steroid days, or parenteral nutrition days. Days to reach full feeds were similar. Infants in the HFNC group were extubated from a higher ventilator rate (32.6±8.5 vs 28±7.5, P ¼ 0.003) and spent fewer days on the ventilator (11.4±12.8 vs 18.5±21, P ¼ 0.028). Rates of ventilatorassociated pneumonia were higher in the control group (P ¼ 0.018). Discharge weights were greater in the HFNC group (P ¼ 0.016) despite similar length of stay and GA at discharge. Conclusion:High-flow nasal cannula use appears safe and well-tolerated. Infants extubated to HFNC spent fewer days on the ventilator. Additional benefits may include a decreased rate of ventilator associated with pneumonia and improved growth.

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Section: Discussionmentioning

confidence: 99%

“…1 Despite its widespread use in many neonatal intensive care units (NICUs), this device has not been rigorously studied in the infant population.…”

Section: Introductionmentioning

confidence: 99%

Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol

2007

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“…and Gram‐negative organisms . Despite these concerns and in the absence of evidence to support its use , HHHFNC has come into widespread use in neonatal units across the globe .…”

Section: Introductionmentioning

confidence: 99%

Use of heated humidified high‐flow nasal cannula oxygen in neonates: a UK wide survey

2012

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“…In fact, considerable questions have been raised about the safety and efficacy of devices that provide relatively unregulated high flow as a means of CPAP delivery. 51 While the mode of delivery for low CPAP in preterm infants will continue to be refined, CPAP use for ventilatory support and treatment of apnea is more widely used than ever in neonatal intensive care.…”

Section: Gastroesophageal Reflux (Ger) and Neonatal Apneamentioning

confidence: 99%

Neonatal Apnea: What's New?

Abu-Shaweesh

Martin

2008

Pediatric Pulmonology

153

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Summary. Apnea of prematurity (AOP) remains a major clinical problem in present day neonatology that warrants frequent evaluations and imposes challenges in therapeutic strategies. Although the pathogenesis of AOP is poorly understood, it is probably a manifestation of physiologic immaturity of breathing control rather than a pathologic disorder. Immature breathing responses to hypoxia, hypercapnia and exaggerated inhibitory pulmonary reflexes in preterm infants might also contribute to the occurrence or severity of AOP. Recent data suggest a role for genetic predisposition. Although typically resolve with maturation, the role of bradycardia and desaturation episodes associated with AOP in the development of sleep disorder breathing and neurodevelopmental delay needs further clarification. Pharmacological treatment with methylxanthines and CPAP remain the mainstay for treatment of AOP. However, recent studies have implicated central inhibitory neuromodulators including prostaglandins, GABA and adenosine in its pathogenesis, the fact that might provide future specific targets for treatment. This review will summarize new insights involving these issues as well as others involving the pathogenesis, treatment strategies and consequences of apnea in premature infants. Pediatr Pulmonol. 2008; 43:937-944. ß

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Preterm VLBW infants: post-extubation respiratory support

Cited by 5 publications

References 11 publications

Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol

Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol

Use of heated humidified high‐flow nasal cannula oxygen in neonates: a UK wide survey

Neonatal Apnea: What's New?

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