Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

White, Heather; Merritt, Kamaris; Martin, Kirsti; Lauer, Emily; Rhein, Lawrence

doi:10.3389/fped.2022.1012655

Cited by 4 publications

(8 citation statements)

References 22 publications

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“…Mechanisms of neonatal lung injury associated with barotrauma, volutrauma, atelectrauma, and oxygen-free radical generation have been widely reviewed. 26 These side effects of assisted ventilation place the preterm infants at high risk of developing severe BPD. In the present study, although the use and duration of IMV remained stable spanning 10-year period, increases were noted in the application of HFV, accompanied by decreases in CMV.…”

Section: Discussionmentioning

confidence: 99%

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Trends in bronchopulmonary dysplasia and respiratory support among extremely preterm infants in China over a decade

Zhu,

He,

Yuan

et al. 2023

Pediatric Pulmonology

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ObjectiveBronchopulmonary dysplasia (BPD) is one of the most serious complications affecting extremely preterm infants. We aimed to evaluate temporal trends in BPD and administration of respiratory support among extremely preterm infants in China over a decade.MethodsThis was a retrospective study using data from a multicenter database, which included infants born less than 28 weeks' gestation discharged from 68 tertiary neonatal care centers in China between 2010 and 2019. Changes in rates and severity of BPD, as well as modalities and duration of respiratory support, were evaluated.ResultsAmong 4808 eligible infants with gestational age (GA) of 21+6/7 to 27+6/7 weeks and a mean (SD) birth weight of 980 (177) g, no significant change of median GA was found over time. Overall, 780 (16.2%) infants died before 36 weeks' postmenstrual age, 2415 (50.2%) were classified as having no BPD, 917 (19.1%) developed Grade 1 BPD, 578 (12.0%) developed Grade 2 BPD, and 118 (2.5%) developed Grade 3 BPD. The rate of BPD increased from 20.8% in 2010 to 40.7% in 2019 (aRR for trend, 1.081; 95% confidence interval, 1.062–1.099), especially for Grade 1 and Grade 2. Although survival to discharge improved over the decade, the overall survival without BPD did not change during the study period. The use of invasive mechanical ventilation (IMV) remained unchanged. However, the use of noninvasive ventilation (NIV) increased from 71.5% in 2010 to 89.8% in 2019. Moreover, the median duration of NIV increased over time, from 17.0 (4.8, 34.0) days in 2010 to 33.0 (21.0, 44.0) days in 2019, without significant change in the duration of IMV.ConclusionsAlthough survival increased over the decade and respiratory support practices changed significantly between 2010 and 2019 in China, with increased use and duration of NIV, there was an increased rate of BPD and survival without BPD has not improved.

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Section: Discussionmentioning

confidence: 99%

“…Mechanisms of neonatal lung injury associated with barotrauma, volutrauma, atelectrauma, and oxygen‐free radical generation have been widely reviewed 26 . These side effects of assisted ventilation place the preterm infants at high risk of developing severe BPD.…”

Section: Discussionmentioning

confidence: 99%

Trends in bronchopulmonary dysplasia and respiratory support among extremely preterm infants in China over a decade

Zhu,

He,

Yuan

et al. 2023

Pediatric Pulmonology

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“…Despite various treatment strategies to prevent BPD development, BPD still remains the most serious chronic lung disease among very preterm infants. Less invasive or non-invasive assisted ventilation, such as nasal CPAP or HFNC, has been applied preferentially to minimize lung injury in VLBW infants ( 15 ). Although controversial, recent practices with active application of non-invasive ventilation, rather than invasive ventilation, has contributed to decrease the incidence of BPD and to improve long-term respiratory function ( 15 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Less invasive or non-invasive assisted ventilation, such as nasal CPAP or HFNC, has been applied preferentially to minimize lung injury in VLBW infants ( 15 ). Although controversial, recent practices with active application of non-invasive ventilation, rather than invasive ventilation, has contributed to decrease the incidence of BPD and to improve long-term respiratory function ( 15 , 16 ). According to the KNN data from 2013 to 2014, BPD incidence was 28.9% ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Required biological time for lung maturation and duration of invasive ventilation: a Korean cohort study of very low birth weight infants

Lim

Cho

2023

Front. Pediatr.

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BackgroundWe investigated the duration of invasive ventilation among very low birth weight (VLBW) infants to evaluate the current minimum time required for lung maturation to breathe without ventilator assistance after preterm birth.MethodsA total of 14,658 VLBW infants born at ≤32+6 weeks between 2013 and 2020 were enrolled. Clinical data were collected from the Korean Neonatal Network, a national prospective cohort registry of VLBW infants from 70 neonatal intensive care units. Differences in the duration of invasive ventilation according to gestational age and birth weight were investigated. Recent trends and changes in assisted ventilation duration and associated perinatal factors between 2017–20 and 2013–16 were compared. Risk factors related to the duration of assisted ventilation were also identified.ResultsThe overall duration of invasive ventilation was 16.3 days and the estimated minimum time required corresponded to 30+4 weeks of gestation. The median duration of invasive ventilation was 28.0, 13.0, 3.0, and 1.0 days at <26, 26–27, 28–29, and 30–32 weeks of gestation, respectively. In each gestational age group, the estimated minimum weaning points from the assisted ventilator were 29+5, 30+2, 30+2, and 31+5 weeks of gestation. The duration of non-invasive ventilation (17.9 vs. 22.5 days) and the incidence of bronchopulmonary dysplasia (28.1% vs. 31.9%) increased in 2017–20 (n = 7,221) than in 2013–16 (n = 7,437). In contrast, the duration of invasive ventilation and overall survival rate did not change during the periods 2017–20 and 2013–16. Surfactant treatment and air leaks were associated with increased duration of invasive ventilation (inverse hazard ratio 1.50, 95% CI, 1.04–2.15; inverse hazard ratio 1.62, 95% CI, 1.29–2.04). We expressed the incidence proportion of ventilator weaning according to the invasive ventilation duration using Kaplan–Meier survival curves. The slope of the curve slowly decreased as gestational age and birth weight were low and risk factors were present.ConclusionsThis population-based data on invasive ventilation duration among VLBW infants suggest the present limitation of postnatal lung maturation under specific perinatal conditions after preterm birth. Furthermore, this study provides detailed references for designing and/or assessing earlier ventilator weaning protocols and lung protection strategies by comparing populations or neonatal networks.

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“…The use of rediscovered NIV techniques in everyday practice of neonatal intensive care in the surfactant era has led to the rediscovery of old drugs as well, such as caffeine, steroids, non-steroid anti-inflammatory drugs, and mother’s milk. In a single-center study, the rate of BPD decreased by more than 50% after starting NIV ventilation together with the early use of caffeine [ 243 ]. Novel research reveals that there are other beneficial effects of caffeine besides preventing or treating apnea in prematurity.…”

Section: Rediscovering Old Drugsmentioning

confidence: 99%

Prevention of Chronic Morbidities in Extremely Premature Newborns with LISA-nCPAP Respiratory Therapy and Adjuvant Perinatal Strategies

et al. 2023

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Less invasive surfactant administration techniques, together with nasal continuous airway pressure (LISA-nCPAP) ventilation, an emerging noninvasive ventilation (NIV) technique in neonatology, are gaining more significance, even in extremely premature newborns (ELBW), under 27 weeks of gestational age. In this review, studies on LISA-nCPAP are compiled with an emphasis on short- and long-term morbidities associated with prematurity. Several perinatal preventative and therapeutic investigations are also discussed in order to start integrated therapies as numerous organ-saving techniques in addition to lung-protective ventilations. Two thirds of immature newborns can start their lives on NIV, and one third of them never need mechanical ventilation. With adjuvant intervention, these ratios are expected to be increased, resulting in better outcomes. Optimized cardiopulmonary transition, especially physiologic cord clamping, could have an additively beneficial effect on patient outcomes gained from NIV. Organ development and angiogenesis are strictly linked not only in the immature lung and retina, but also possibly in the kidney, and optimized interventions using angiogenic growth factors could lead to better morbidity-free survival. Corticosteroids, caffeine, insulin, thyroid hormones, antioxidants, N-acetylcysteine, and, moreover, the immunomodulatory components of mother’s milk are also discussed as adjuvant treatments, since immature newborns deserve more complex neonatal interventions.

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Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

Cited by 4 publications

References 22 publications

Trends in bronchopulmonary dysplasia and respiratory support among extremely preterm infants in China over a decade

Trends in bronchopulmonary dysplasia and respiratory support among extremely preterm infants in China over a decade

Required biological time for lung maturation and duration of invasive ventilation: a Korean cohort study of very low birth weight infants

Prevention of Chronic Morbidities in Extremely Premature Newborns with LISA-nCPAP Respiratory Therapy and Adjuvant Perinatal Strategies

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