Respiratory support of infants born at 22–24 weeks of gestational age

Norman, Mikael; Jónsson, Baldvin; Wallström, Linda; Sindelar, Richard

doi:10.1016/j.siny.2022.101328

Cited by 20 publications

(24 citation statements)

References 56 publications

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“…The respiratory support provided to preterm infants is largely determined by unit practices and guidelines [7]. The SNQ provides annual reports on variation between regions/units and practice changes over time.…”

Section: Discussionmentioning

confidence: 99%

“…For this study, all infants delivered at 22–31 week gestation, reported daily to SNQ, and discharged to home between November 2015 and April 2022 were included ( N = 3,368). Based on previous work demonstrating a very skewed distribution of mortality across the GA range [22], and that half of those who died after births at 24–28 weeks GA did so in the first postnatal week [23] despite active management [7], we decided to exclude infants who died during neonatal care ( n = 364). Infants with more than minor malformations as defined by European network of population-based registries for the epidemiological surveillance of congenital anomalies (EUROCAT) [24] were also excluded ( n = 339).…”

Section: Methodsmentioning

confidence: 99%

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Patterns of Respiratory Support by Gestational Age in Very Preterm Infants

et al. 2022

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Introduction: A detailed understanding of respiratory support patterns in preterm infants is lacking. The aim was to explore and visualize this practice in Sweden. Methods: Preterm infants with gestational ages of 22–31 weeks, admitted to neonatal units reporting daily to the Swedish Neonatal Quality Register and discharged alive in November 2015–April 2022, were included in this descriptive cohort study. Proportions receiving mechanical ventilation, noninvasive support, or supplemental oxygen were calculated and graphically displayed for each gestational week and postnatal day (range 0–97) up to hospital discharge or 36 weeks of postmenstrual age. Results: Respiratory support in 148,515 days of care (3,368 infants; 54% males; median [interquartile range] birthweight = 1,215 [900–1,525] g) was evaluated. Trajectories showed distinct nonlinear patterns for each category of respiratory support, but differences in respiratory support over the gestational age range were linear: the proportion of infants on mechanical ventilation decreased by −11.7 to −7.3% (variability in estimates related to the postnatal day chosen for regression analysis) for each week higher gestational age (r = −0.99 to −0.87, p ≤ 0.001). The corresponding proportions of infants with supplemental oxygen decreased by −12.4% to −4.5% for each week higher gestational age (r = −0.98 to −0.94, p < 0.001). At 36 weeks of postmenstrual age, dependencies on mechanical ventilation, noninvasive support, and supplemental oxygen varied from 3%, 84%, and 94% at 22 weeks to 0%, 3%, and 5% at 31 weeks of gestational age, respectively. Conclusions: Respiratory support patterns in very preterm infants follow nonlinear, gestational age-specific postnatal trajectories in a dose-response-related fashion.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Patterns of Respiratory Support by Gestational Age in Very Preterm Infants

et al. 2022

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“…As described in a recent review, data from the Swedish National Quality Registry show, that in the years before the CORSAD trial more than two‐thirds of all infants born at 25 weeks or less were intubated in the delivery room and during the CORSAD trial period the intubation rates for infants born alive at 22–23 weeks remained high. For infants born at 24 and 25 weeks, intubation rates declined nationally though still remaining at a significantly higher level compared to infants in the rPAP group in the present study cohort 27 . This indicates that the rPAP system may facilitate the continuing trend towards successful non‐invasive delivery room stabilisation in this group of immature infants who were previously intubated in the delivery room.…”

Section: Discussionmentioning

confidence: 50%

Respiratory outcomes after delivery room stabilisation with a new respiratory support system using nasal prongs

et al. 2023

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The aim of modern neonatal stabilisation and respiratory support is to support the infants breathing with minimally invasive methods to reduce the risk of developing bronchopulmonary dysplasia (BPD).International treatment recommendations and guidelines recommend continuous positive airway pressure (CPAP) for spontaneously breathing infants rather than intubation and intermittent positive pressure ventilation. [1][2][3] This approach is based on randomised controlled trials and meta-analyses showing a reduction in the combined

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“…The superiority of HFOV over IPPV for lung protection has not yet been proven, 19 although we might expect superiority due to the use of lower tidal volumes 6 in this ventilatory mode in preterm patients. 20 IPPV with volume guarantee mode induces lower expression of early inflammation markers than HFOV, 21 which is contradictory to the expected protective effect of HFOV. Our study suggest that inadequate humidification could be a factor explaining potential excess inflammation during HFOV.…”

Section: Discussionmentioning

confidence: 87%

Humidity during high-frequency oscillatory ventilation compared to intermittent positive pressure ventilation in extremely preterm neonates: an in-vitro and in-vivo observational study.

Danan

Tauzin

Jung

et al. 2022

Preprint

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Background: Inappropriate humidification of inspired gas during mechanical ventilation can impair lung development in extremely low birthweight (ELBW) infants. Humidification depends on multiple factors, such as the heater-humidifier device used, type of ventilation, and environmental factors. Few studies have examined inspired gas humidification in these infants, especially during high-frequency oscillatory ventilation (HFOV). Our objective was to compare humidity during HFOV and intermittent positive pressure ventilation (IPPV), in vitro and in vivo. Methods: In-vitro and in-vivo studies used the same ventilator during both HFOV and IPPV. The bench study used a neonatal test lung and 2 heater-humidifiers with their specific circuits; the in-vivo study prospectively included preterm infants born before 28 weeks of gestation. Results: On bench testing, mean absolute (AH) and relative (RH) humidity values were significantly lower during HFOV than IPPV (RH = 79.4% ± 8.1% vs 89.0% ± 6.2%, P<0.001). Regardless of the ventilatory mode, mean relative humidity significantly differed between the 2 heater-humidifiers (89.6% ± 6.7% vs 78.7% ± 6.8%, P=0.003). The in-vivo study included 10 neonates (mean ± SD gestational age: 25.7 ± 0.9 weeks and birth weight: 624.4 ± 96.1 g). Mean relative humidity during HFOV was significantly lower than during IPPV (74.6% ± 5.7% vs 83.0 ± 6.7%, P=0.004). Conclusion: Relative humidity was significantly lower during HFOV than IPPV, both in vitro and in vivo. The type of heater-humidifier also influenced humidification. More systematic measurements of humidity of inspired gas, especially during HFOV, should be considered to optimize humidification and consequently lung protection in ELBW infants.

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Respiratory support of infants born at 22–24 weeks of gestational age

Cited by 20 publications

References 56 publications

Patterns of Respiratory Support by Gestational Age in Very Preterm Infants

Patterns of Respiratory Support by Gestational Age in Very Preterm Infants

Respiratory outcomes after delivery room stabilisation with a new respiratory support system using nasal prongs

Humidity during high-frequency oscillatory ventilation compared to intermittent positive pressure ventilation in extremely preterm neonates: an in-vitro and in-vivo observational study.

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