Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years

Doyle, Lex W.; Carse, Elizabeth; Adams, Anne-Marie; Ranganathan, Sarath; Opie, Gillian; Cheong, Jeanie L.Y.

doi:10.1056/nejmoa1700827

Cited by 212 publications

(131 citation statements)

References 17 publications

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“…In a large cohort following preterm infants born between 1992 and 2005 with the mean GA of 25 weeks, Doyle et al [27, 28] showed that despite substantial increases in the use of less invasive ventilation after birth, there was no significant decline in oxygen dependence at 36 weeks and no significant improvement in lung function in childhood at 8 years of age. However, nHFT has increasingly been used in their region since then, and the association of such a change with long-term lung function remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure

et al. 2018

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Aim: To evaluate the effectiveness of nasal high-flow therapy (nHFT) as primary respiratory support for preterm infants with respiratory distress syndrome (RDS) in two tertiary neonatal units. Methods: A retrospective outcome analysis of initial respiratory support strategies was performed in two tertiary neonatal units in the UK: John Radcliffe Hospital (JRH), Oxford and St Peter’s Hospital (SPH), Chertsey. Infants born between 28⁺⁰ and 36⁺⁶ weeks gestational age (GA) between May 2013 and June 2015 were included. Results: A total of 381 infants, 191 from JRH and 190 from SPH, were analysed. Infants were stabilised in the delivery room using mask continuous positive airway pressure followed by nHFT. Endotracheal intubation was performed according to local protocols, depending on the severity of RDS. There were significant differences in initial intubation rates according to GA (26% JRH vs. 16.9% SPH, p < 0.001 for babies < 32 weeks GA, and 8.2% JRH vs. 6.5% SPH, p < 0.001 for babies > 32 weeks GA); however, most infants were successfully transitioned to nHFT. Intubation rates during the first 72 h were comparable between centres (14.7% JRH vs. 11.1% SPH, p = 0.29). There were no differences in neonatal morbidities, including air leak, duration of oxygen supplementation, bronchopulmonary dysplasia, sepsis, retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, or median time to full-suck feeds. Conclusion: Use of nHFT for primary respiratory support, without use of nasal continuous positive airway pressure as “rescue” treatment, resulted in intubation rates lower or comparable to published data from randomised controlled trials.

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Section: Discussionmentioning

confidence: 99%

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure

et al. 2018

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“…4,8,11,15,16 Further supporting the notion of establishing an evidence-based approach is a paper published by Doyle et al; this group followed up preterm infants at 8 years, examining three different cohorts at different time periods. 17 The first cohort was 1991-1992, second 1997 and the third 2005. The authors concluded that despite advances in ventilation and treatment modes, there had been no significant decrease in the number of babies with CNLD.…”

Section: Key Pointsmentioning

confidence: 99%

The use of overnight oximetry in neonates: A literature review

Flint

Davies

2018

J Paediatrics Child Health

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There is much debate between neonatologists and paediatricians about appropriate oxygen saturation targets for babies with chronic neonatal lung disease (CNLD). Overnight oximetry is used to guide the fraction of inspired oxygen to use. We did this literature review to examine the current literature on the use of overnight oximetry in term infants, preterm infants and babies with CNLD (especially relevant to ex-preterm babies with CNLD going home on oxygen). We reviewed the literature from January 1990 to October 2017 by searching the following databases: Cochrane Central Register of Controlled Trials, The Joanna Briggs Institute, CINAHL, MEDLINE, Scopus, EMBASE, ProQuest and Science Direct. Sixteen articles were included in the review. The literature available on overnight oximetry in neonates is limited, it is not contemporary, and it reports studies that did not use oximeters with modern software for data collection and analysis. It is imperative that reference ranges be defined for overnight oximetry parameters so that babies are not inadvertently administered inappropriate amounts of oxygen.

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“…Despite advances in neonatal intensive care, bronchopulmonary dysplasia (BPD) continues to be a common complication in premature infants, especially those born extremely premature (<28 weeks' gestation) . BPD has significant impact on the health of the infant in the neonatal period and early childhood and leads to increased risk of long‐term respiratory issues, such as reactive airway disease, impaired lung function, and exercise intolerance . Severe BPD is also associated with developmental delay and other neuromorbidities in children …”

Section: Introductionmentioning

confidence: 99%

“…1,2 BPD has significant impact on the health of the infant in the neonatal period and early childhood and leads to increased risk of long-term respiratory issues, such as reactive airway disease, impaired lung function, and exercise intolerance. 3,4 Severe BPD is also associated with developmental delay and other neuromorbidities in children. 5 At a pathophysiological level, BPD is characterized by vascular maldevelopment, impaired alveolarization, and lung inflammation.…”

Section: Introductionmentioning

confidence: 99%

Two-year outcomes of infants enrolled in the first-in-human study of amnion cells for bronchopulmonary dysplasia

Malhotra

Lim

Mockler

et al. 2019

Stem Cells Translational Medicine

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We previously reported on the immediate safety and neonatal outcomes of six premature infants with severe bronchopulmonary dysplasia (BPD) who were administered human amnion epithelial cells (hAECs). One infant died in the neonatal period due to unrelated causes. In this study, we aimed to assess the long‐term safety and follow‐up outcomes of the five surviving infants until 2 years corrected age (CA). hAECs were administered intravenously at a dose of 1 × 106 cells per kilogram after 36 weeks postconceptional age in infants with established BPD. Study follow‐up consisted of assessment of any adverse events, growth, and respiratory, cardiac, and neurodevelopmental outcomes over four time points (6, 12, 18, and 24 months CA). Investigations included chest x‐rays, cranial and abdominal ultrasounds, and echocardiograms at regular intervals as well as a magnetic resonance imaging (MRI) brain at 2 years CA. All five infants were alive at 2 years CA. Median time to wean off oxygen was 24 (10‐36) months. Two infants had pulmonary hypertension, which resolved by 2 years of age. Four infants were rehospitalized briefly for viral or bacterial infections during the 2 years. MRI brain findings included normal (n = 1), and mild to moderate white matter loss (n = 2). Neurodisabilities diagnosed included hemiplegic cerebral palsy (n = 1), global developmental delay (n = 3), and severe hearing loss (n = 3). No evidence of tumor formation was noted on physical examinations or on any imaging. There were no long‐term adverse events observed that could be attributed to hAEC administration. We observed long‐term effects of extreme prematurity and severe BPD in the cohort.

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Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years

Cited by 212 publications

References 17 publications

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure

The use of overnight oximetry in neonates: A literature review

Two-year outcomes of infants enrolled in the first-in-human study of amnion cells for bronchopulmonary dysplasia

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